Mayo Clinic established a reconstructive transplant program as an extension of clinical practice in 2010. A 31-year-old Caucasian male had significant functional limitations and disfigurement despite multiple conventional reconstructive procedures following a self-inflicted gunshot to the face. These limited his social interactions and potential for career advancement due to inability to pass fitting of required safety equipment.

He was referred for transplant 7 years after his injury and was listed for transplant after 2 1/2 years of evaluation, education, psychosocial assessment and follow-up. The surgical team rehearsed the planned surgery over 50 Saturdays in the anatomy lab. Guides developed by Medical Modeling using 3D CT reconstruction aided bone cuts. The patient received a blood group compatible, negative flow cross match, no DSA transplant. Donor and recipient were EBV negative but CMV mismatched (D+/R-). The graft consisted of all facial tissues from below the eyelids including maxilla, mandible and upper and lower teeth. Immunosuppression consisted of anti-thymocyte globulin (ATG) induction and a triple immunosuppressive regimen consisting of tacrolimus, mycophenolate mofetil, and corticosteroids.

The patient recovered well from surgery. The aesthetic result was deemed good by the patient “better than I expected”. He regained his sense of smell, the ability to chew food (prior to the transplant he had only two molar teeth with significant microstomia). Gradually nerve regeneration progressed with the ability to smile and coapt his lips. Nasal breathing was also possible. One VCA Banff grade two rejection occurred on day 57-post transplant. This was successfully treated with a course of pulse corticosteroids. Seven months after transplant asymptomatic primary CMV infection was detected on surveillance. A short course of valganciclovir controlled the infection. One year after transplant two-point discrimination was 5 mm. Surveillance biopsy showed no inflammation and no donor specific antibodies were detected.

Seventeen months from transplant renal function remains preserved and functional recovery continues with the patient progressing in his chosen career and social integration.

CITATION INFORMATION: Amer H., Jowsey-Gregoire S., Rosen C., Razonable R., Reid K., Gandhi M., Ewoldt L., Edwards B., Mardini S. Mayo Clinic's First Face Transplant: 17 Months On Am J Transplant. 2017;17 (suppl 3).

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