The decade of face transplant outcomes

  • Maria SiemionowEmail author
Tissue Regeneration or Regeneration of Engineered Tissue? Review Article
Part of the following topical collections:
  1. Tissue Regeneration or Regeneration of Engineered Tissue?


At the 10th year anniversary of the first face transplantation, 37 patients worldwide, were the recipients of faces coming from human donors. Five patients died due to complications, noncompliance with immunosuppressive medications and development of cancer. Despite the initial debates and ethical concerns, face transplantation became a clinical reality with satisfactory functional outcomes. The areas of controversy still include the impact of life-long immunosuppression on otherwise healthy patients as well as the selection process of face transplant candidates. Other concerns include financial support for this new generation of transplants as well as social re-integration and patients return to work after face transplantation. Based on over 20 years of research experience in the field of vascularized composite allotransplantation (VCA), and clinical experience as a leading surgeon of the US first face transplantation, this review will summarize the well—known facts as well as unexpected outcomes and challenges of face transplantation.

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Conflict of interest

The authors declare that they have no competing interests.


  1. 1.
    Siemionow MZ, Gordon CR. Institutional review board-based recommendations for medical institutions pursuing protocol approval for facial transplantation. Plast Reconstr Surg. 2010;126:1232–9.CrossRefGoogle Scholar
  2. 2.
    Devauchelle B, Badet L, Lengele B, et al. First human face allograft: early report. Lancet. 2006;368:203–9.CrossRefGoogle Scholar
  3. 3.
    Siemionow M, Papay F, Alam D, et al. Near-total human face transplantation for a severely disfigured patient in the USA. Lancet. 2009;374:203–9.CrossRefGoogle Scholar
  4. 4.
    Siemionow MZ, Papay F, Djohan R, et al. First U.S. near-total human face transplantation: a paradigm shift for massive complex injuries. Plast Reconstr Surg. 2010;125:111–22.CrossRefGoogle Scholar
  5. 5.
    Morelon E, Petruzzo P, Kanitakis J, Dakpé S, Thaunat O, Dubois V, Choukroun G, Testelin S, Dubernard JM, Badet L, Devauchelle B. Face transplantation: partial graft loss of the first case ten years later. Am J Transplant. 2017 Jan 31. doi: 10.1111/ajt.14218.
  6. 6.
    Siemionow M. The miracle of face transplantation after 10 years. Br Med Bull. 2016;120(1):5–14.CrossRefGoogle Scholar
  7. 7.
    Wo L, Bueno E, Pomahac B. Facial transplantation: worth the risks ? A look at evolution of indications over the last decade. Curr Opin Organ Transplant. 2015;20:615–20.Google Scholar
  8. 8.
    Siemionow M, Gordon CR. Overview of guidelines for establishing a face transplant program: a work in progress. Am J Transplant. 2010;10:1290–6.CrossRefGoogle Scholar
  9. 9.
    Paradis C, Siemionow M, Papay F, et al. Ethical considerations in the first American face transplant. Plast Reconstr Surg. 2010;126:896–901.CrossRefGoogle Scholar
  10. 10.
    Siemionow MZ, Rampazzo A, Gharb BB. Addressing religious and cultural differences in views on transplantation, including composite tissue allotransplantation. Ann Plast Surg. 2011;66:410–5.CrossRefGoogle Scholar
  11. 11.
    Barret JP. From partial to full-face transplantation: total ablation and restoration, a change in the reconstructive paradigm. Int J Surg. 2014;12:109–12.CrossRefGoogle Scholar
  12. 12.
    Khalifian S, Brazio PS, Mohan R, et al. Facial transplantation: the first 9 years. Lancet. 2014;384:2153–63.CrossRefGoogle Scholar
  13. 13.
    Maciejewski A, Krakowczyk L, Szymczyk C, et al. The first immediate face transplant in the world. Ann Surg. 2016;263:e36–9.CrossRefGoogle Scholar
  14. 14.
    Lemmens GM, Poppe C, Hendrickx H, et al. Facial transplantation in a blind patient: psychologic, marital, and family outcomes at 15 months follow-up. Psychosomatics. 2015;56:362–70.CrossRefGoogle Scholar
  15. 15.
    Coffman KL, Gordon C, Siemionow M. Psychological outcomes with face transplantation: overview and case report. Curr Opin Organ Transplant. 2010;15:236–40.Google Scholar
  16. 16.
    Stokes M. A decade of facial transplantation: Lessons learned and what lies ahead. Plastic Surgery News. 2016;1:24–25.Google Scholar
  17. 17.
    Siemionow M, Ozturk C. An update on facial transplantation cases performed between 2005 and 2010. Plast Reconstr Surg. 2011;128:707e–20e.CrossRefGoogle Scholar
  18. 18.
    Siemionow M, Ozturk C. Face transplantation: outcomes, concerns, controversies, and future directions. J Craniofac Surg. 2012;23:254–9.CrossRefGoogle Scholar
  19. 19.
    Fischer S, Kueckelhaus M, Pauzenberger R, Bueno EM, Pomahac B. Functional outcomes of face transplantation. Am J Transplant. 2015;15:220–33.CrossRefGoogle Scholar
  20. 20.
    Giatsidis G, Sinha I, Pomahac B. Reflections on a decade of face transplantation. Ann Surg. 2016;265(4):841–846.Google Scholar
  21. 21.
    Alam DS, Papay F, Djohan R, et al. The technical and anatomical aspects of the world’s first near-total human face and maxilla transplant. Arch Facial Plast Surg. 2009;11:369–77.CrossRefGoogle Scholar
  22. 22.
    Hashem AM, Hoffman GS, Gastman B, Bernard S, Djohan R, Hendrickson M, Schwarz G, Doumit G, Gharb BB, Rampazzo A, Zins JE, Siemionow M, Papay F. Establishing the feasibility of face transplantation in granulomatosis with polyangiitis. Am J Transplant. 2016;16(7):2213–23.CrossRefGoogle Scholar
  23. 23.
    Lantieri L, Meningaud JP, Grimbert P, et al. Repair of the lower and middle parts of the face by composite tissue allotransplantation in a patient with massive plexiform neurofibroma: a 1-year follow-up study. Lancet. 2008;372:639–45.CrossRefGoogle Scholar
  24. 24.
    Roche NA, Blondeel PN, Van Lierde KM, Vermeersch HF. Facial transplantation: history and update. Acta Chir Belg. 2015;115:99–103.CrossRefGoogle Scholar
  25. 25.
    Sosin M, Ceradini DJ, Levine JP, Hazen A, Staffenberg DA, Saadeh PB, Flores RL, Sweeney NG, Bernstein GL, Rodriguez ED. Total face, eyelids, ears, scalp, and skeletal subunit transplant: a reconstructive solution for the full face and total scalp burn. Plast Reconstr Surg. 2016;138(1):205–19.Google Scholar
  26. 26.
    Lantieri L, Grimbert P, Ortonne N, Suberbielle C, Bories D, Gil-Vernet S,Lemogne C, Bellivier F, Lefaucheur JP, Schaffer N, Martin F, Meningaud JP,Wolkenstein P, Hivelin M. Face transplant: long-term follow-up and results of a prospective open study. Lancet. 2016;388(10052):1398–1407.Google Scholar
  27. 27.
    Coffman KL, Siemionow MZ. Ethics of facial transplantation revisited. Curr Opin Organ Transplant. 2014;19:181–7.CrossRefGoogle Scholar
  28. 28.
    Aycart MA, Kiwanuka H, Krezdorn N, Alhefzi M, Bueno EM, Pomahac B, Oser ML. Quality of life after face transplantation: outcomes, assessment tools, and future directions. Plast Reconstr Surg. 2017;139(1):194–203.Google Scholar
  29. 29.
    Kanitakis J, Petruzzo P, Gazarian A et al. Premalignant and malignant skin lesions in two recipients of vascularized composite tissue allografts (Face, Hands). Case Rep Transplant 2015;2015:4.Google Scholar
  30. 30.
    Siemionow M. Vascularized composite allotransplantation: a new concept in musculoskeletal regeneration. J Mater Sci Mater Med. 2015;26:266.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Department of OrthopaedicsUniversity of Illinois at ChicagoChicagoUSA

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