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Face Transplant Frequently Asked Questions

What is CTA?

CTA stands for Composite Tissue Allotransplantation and is the umbrella term for transplantations composed of multiple tissues like the hand or face.

Who is on the UPMC Face Transplant Team?

Joseph E. Losee, M.D., UPMC Face Transplant Program Team Leader

Vijay Gorantla, M.D., Ph.D., Director, UPMC Composite Tissue Transplant Program

Who is eligible to participate in the UPMC Face Transplant Study?

People between the ages of 18 and 65 with significant facial injury, trauma, deficits or deformities including but not limited to mid-face structures are eligible. Those who fit this criteria will be rigorously evaluated before being considered candidates for face transplantation. For more information on participating in the study, visit the Department of Plastic and Reconstructive Surgery. How many total face transplants have been performed in the United States?

Two patients have received face transplants at institutions in the United States, the first in 2008.

What is the protocol proposed for the face transplant program at UPMC and how is it different from current regimens?

Surgeons and researchers here are proposing the use of the Pittsburgh Protocol for immunosuppression after face transplant. It is composed of two elements: treating the patient with antibodies the day of transplant, followed by a donor bone marrow infusion several days later.  When used in solid organ and hand transplants at UPMC, this protocol allows patients to be treated with low doses of a single maintenance drug.

What is rejection after face transplantation?

Rejection refers to the body’s immune response towards the newly transplanted facial tissues. Believing the tissues to be “foreign,” the body’s natural response is to attack and can occur within days to months after transplant.

How is rejection detected or diagnosed in face transplants?

Rejection can appear as a rash on the transplanted tissues that could be spotty, patchy or blotchy. It could appear anywhere on the transplant and is usually painless. As rejection almost always appears first in the skin, patients are encouraged to carefully watch for the signs and report to the physician for timely biopsy and treatment. Unlike internal organ transplants, where rejection is difficult to spot early, it is easy to detect and monitor in the face, allowing for early medical intervention.

How is a donor face selected for transplantation?

Special care is taken to match not only the biological factors, including blood and tissue type, but also gender, race and skin tone to ensure that an aesthetically pleasing result is achieved. 

How is a face transplant performed?

For each face transplant recipient, a tailored, need-based plan is devised. Surgeons remove tissues from the donor and use microvascular techniques to graft these tissues to the recipient.

Does the recipient who receives donated facial tissues physically resemble the donor post transplantation?

Research has shown that the resulting appearance of patients who receive a face transplant will be a composite of the features of the donor and the recipient depending on the nature and quality of tissues transplanted.

Can patients expect to regain basic functions like taste and smell and sensation from the transplanted tissues?

In patients around the world who have received face transplants, many have regained not only the form of the face, but have also been able to breathe normally, taste and smell and have sensation in the transplanted tissues.

What is the current status and future of CTA?

In the last decade, around 80 different CTA surgeries have been performed with success. Since its inception, CTA has faced and endured much speculation, debate, controversy and scrutiny. Early world outcomes have confirmed that satisfactory to excellent function can be achieved with these types of procedures.

The goal now is successful avoidance of the risks of high-dose multiple drug therapy to prevent rejection. Strategies like the Pittsburgh Protocol that aim to minimize maintenance immunosuppression have been studied in organ and hand transplantation at UPMC. Realization of such protocols in clinical CTA will herald a new era of reconstructive transplant surgery to treat complex and major tissue defects.

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