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10-Year Immunologic Outcomes After the First Full Face, Eyelid, Ear, and Scalp Transplant
Alexis K. Gursky
*1, Hailey P. Wyatt
1, Sergio A. Segrera
1, Anandhini Narayanan
1, Bruce E. Gelb
2, Daniel J. Ceradini
1, Eduardo Rodriguez
11Hansjörg Wyss Department of Plastic Surgery, New York University Langone, New York, NY; 2Transplant Institute, Department of Surgery, New York University Langone, New York, NY
Background: Over 50 face transplants have been performed worldwide, with fewer than 10 US recipients surviving beyond 10 years. We present the 10-year follow-up of the first full-face, eyelid, ear, and scalp transplant, highlighting the management of a severe acute rejection episode and chronic antibody-mediated rejection (AMR).
Methods: A 10-year post-transplant chart review was conducted. Data included rejection episodes, immunologic course with serial donor-specific antibody (DSA) levels, dermatopathology findings, and immunosuppressive management.
Results: Over 10 years, the patient experienced two biopsy-proven Banff II acute rejection episodes. The first, at POY 4, after a sunburn, was C4d-negative with transient DSA and resolved with pulse steroids. The second, at POY 7, following poor follow-up during the COVID-19 pandemic, showed focal C4d positivity and class II DSA consistent with ARM. Upon re-establishing care in 2023 (POY 7), he presented with facial erythema, pigmentary changes, alopecia, and a large ulcerated retroauricular wound involving the ear. Multimodal therapy, including plasmapheresis with IVIG, pulse steroids, and increased immunosuppression, resolved his acute rejection and reversed graft breakdown. The patient has progressed to chronic AMR with rebound class II DSA and a positive endothelial crossmatch, managed with plasmapheresis approximately every six months and close DSA surveillance, which has stabilized skin changes and prevented further rejection.
Conclusion: This 10-year follow-up of our institution's first face transplant demonstrates long-term graft survival, successful management of a severe rejection episode with remarkable wound healing, and underscores the need for standardized criteria and longitudinal monitoring in chronic VCA rejection.
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