Based on groundbreaking research and experience in solid-organ and hand transplants, the University of Pittsburgh Medical Center (UPMC) has begun a novel clinical study on human face transplantation that seeks to reduce the use of immunosuppressive drugs and their damaging side effects for patients.
“For people suffering from the worst facial deformities and injuries, standard surgical procedures are often times not enough to give them back a recognizable face, because surgeons are unable to give them back a nose, lips or eyelids,” said Joseph E. Losee, M.D., face transplant program team leader and professor in the division of plastic surgery at UPMC and chief of pediatric plastic surgery at Children’s Hospital of Pittsburgh of UPMC.
“So much of our social interaction is based on facial expression, and for those who have a devastating facial injury, that ability is lost. Our hope is to restore the form of our patients faces as well as functions such as taste and smell and sensation, allowing them to engage in social situations without being the negative center of attention,” said Dr. Losee.
Although surgeons from selected medical centers around the world have performed face transplants successfully, they have used multiple immunosuppressive medications to prevent rejection of the grafts, increasing the risk of diabetes, hypertension and other disorders.
In contrast, researchers and surgeons at UPMC have implemented an immunomodulatory approach known as the “Pittsburgh Protocol,” which entails donor bone marrow cell infusion and treatment with a reduced amount of immunosuppressive drugs to reduce toxicity for patients.
Surgeons at UPMC have adapted a two-phase protocol that involves initial antibody treatment followed by bone marrow cell therapy. The goal is not merely to suppress the immune system but to change the way it functions. Transplant patients will receive antibodies to help overcome the initial overwhelming immune response. That will be followed by a bone marrow infusion several days post transplant. The bone marrow cells target specific cells that could reject the grafted tissues and help “re-educate” the immune system into thinking that the transplanted graft is not a foreign object. Patients will be treated with tacrolimus, a drug that was first used in liver transplants by Thomas Starzl, M.D., Ph.D., over two decades ago, to maintain the low-grade immunosuppression needed to prevent long-term graft rejection.
The Pittsburgh Protocol has proven successful thus far in hand transplant recipients at UPMC, with five patients currently being maintained on a low-dosage of immunosuppression drugs with very few episodes of rejection.
Face Transplant Study Protocol
UPMC researchers are seeking patients between the ages of 18 and 65 with a facial tissue injury or deformity who are interested in receiving a face transplant. Selected patients will undergo intensive medical screenings and psychological evaluation. Eligible subjects will be invited to undergo a comprehensive informed consent process and placed on the transplant list to await a potential donor. Those who receive transplants will be expected to stay in the Pittsburgh area after the surgery to undergo therapy and careful monitoring and assessment of the transplanted tissues by physicians.
For more information on enrollment in the hand transplant program, please call (412) 648-9207.