Human facial allotransplantation: a 2-year follow-up study
Human facial allotransplantation: a 2-year follow-up study
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人类面部同种异体移植：一项为期 2 年的随访研究
DOI：
10.1016/s0140-6736(08)61276-3
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发表时间：
2008-08-23
期刊：
影响因子：
168.9
通讯作者：
Li, Huiyuan
中科院分区：
文献类型：
--
作者：
Guo, Shuzhong;Han, Yon;Li, Huiyuan
背景复合组织异体移植的研究进展可能为严重面部畸形患者提供新的治疗方法。我们在2006年做了一个面部部分异体移植，并在这里报告了患者2年的随访。方法患者为一名30岁的中国男子，于2004年10月被熊严重咬伤面部。经过精心的系统准备，于2006年4月行同种异体复合组织移植。手术内容包括右下颌动脉与面前静脉吻合，全鼻、上唇、腮腺、上颌窦前壁、部分眶下壁、颧骨全修复。术中行面神经吻合。采用四联免疫调节治疗，包括他克莫司、霉酚酸酯、皮质类固醇和人源化IL-2受体单克隆抗体。随访包括外周血T淋巴细胞亚群、病理和免疫组化检查、功能进展和心理支持。结果复合组织瓣成活良好。移植后3个月、5个月和17个月发生了3次急性排斥反应，但通过调整他克莫司剂量或应用甲基强的松龙脉冲治疗，这些反应得到了控制。肝肾功能正常，无感染。患者于移植后第3天出现高血糖，经药物控制。面部移植可以在短期内取得成功，但手术过程并非没有并发症。然而，有希望的结果可能意味着这种手术可能是严重面部畸形长期修复的一种选择。西京医院临床新技术基金资助。
Background Progress in composite tissue allotransplantation could provide a new treatment for patients with severe facial disfigurements. We did a partial facial allotransplantation in 2006, and report here the 2 year follow-up of the patient.Methods The recipient, a 30-year-old man from China, had his face severely injured by a bear in October, 2004. Allograft composite tissue transplantation was done in April, 2006, after careful systemic preparation. The surgery included anastomosis of the right mandibular artery and anterior facial vein, whole repair of total nose, upper lip, parotid gland, front wall of the maxillary sinus, part of the infraorbital wall, and zygomatic bone. Facial nerve anastomosis was done during the surgery. Quadruple inummomodulatory therapy was used, containing tacrolimus, mycophenolate mofetil, corticosteroids, and humanised IL-2 receptor monoclonal antibody. Follow-up included T lymphocyte subgroups in peripheral blood, pathological and immunohistochemical examinations, functional progress, and psychological support.Findings Composite tissue flap survived well. There were three acute rejection episodes at 3, 5, and 17 months after transplantation, but these were controlled by adjustment of the tacrolimus dose or the application of methylprednisolone pulse therapy. Hepatic and renal functions were normal, and there was no infection. The patient developed hyperglycaemia on day 3 after transplantation, which was controlled by medication.Interpretation Facial transplantation could be successful in the short term, but the procedure was not without complications. However, promising results could mean that this procedure might be an option for long-term restoration of severe facial disfigurement.Funding New Clinical Technique Foundation of Xijing Hospital.