Face Transplantation in a Highly Sensitized Recipient

Area of Science:

• Transplantation immunology
• Reconstructive surgery

Background:

• A 45-year-old female with severe chemical burns and poor quality of life underwent face transplantation.
• The recipient had high levels of anti-human leukocyte antigen (HLA) antibodies (98% panel reactive antibody score) and positive crossmatches.

Observation:

• Early post-transplant antibody-mediated rejection occurred, evidenced by swelling, rising anti-HLA titers, and C4d deposition.
• Initial immunosuppression with plasmapheresis, thymoglobulin, mycophenolate mofetil, tacrolimus, and steroids was insufficient.

Findings:

• A salvage therapy regimen including plasmapheresis, eculizumab, bortezomib, and alemtuzumab was initiated after rejection progression.
• This combination therapy successfully reduced anti-HLA antibody levels and resolved rejection signs by 3 months post-transplant.

Implications:

• This case demonstrates the feasibility of face transplantation in highly sensitized recipients with positive crossmatches.
• Effective management of antibody-mediated rejection with novel therapeutic combinations is crucial for successful facial allotransplantation.