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首次人类面部再移植的临床报告
作者:小柯机器人 发布时间:2020/11/29 22:06:12

法国巴黎公共援助医院Laurent Lantieri团队对首例人类面部再移植进行了30个月的随访。2020年11月28日,该研究发表在《柳叶刀》杂志上。

自2005年首次成功进行面部移植以来,这种手术在美观、功能和生活质量方面的优势已牢固确立。然而,尽管进行了免疫抑制治疗,同种异体移植物的长期存活可能会因慢性抗体介导的排斥反应(CAMR)而受损,从而导致组织不可逆的坏死。在没有治疗选择的情况下,这种并发症不可避免地危及生命。

研究组报道了一名男子的面部再移植情况,他在第一次面部移植后8年,因为1型神经纤维瘤病而大面积毁容,6周后,由于严重的CAMR完全失去了他的同种异体移植物。研究组描述了与免疫相关的最终导致同种异体坏死和面部移植损失问题的时间表,用于高度免疫敏化受体的脱敏方案,手术的外科技术,该患者的具体心理管理,以及30个月随访的结果。

尽管患者的术后病程很复杂,并伴有许多免疫、感染、心肺和心理事件,但在住院近一年后顺利出院。此后,他重新融入自己的社区,生活质量得到了可接受的恢复。

这是第一个有文献记载的人类面部再移植的临床报告,它证明了CAMR术后的面部移植损失可以通过再移植和积极的脱敏过程成功缓解。

附:英文原文

Title: First human facial retransplantation: 30-month follow-up

Author: Laurent Lantieri, Bernard Cholley, Cedric Lemogne, Romain Guillemain, Nicolas Ortonne, Philippe Grimbert, Eric Thervet, Alexandre G Lellouch

Issue&Volume: 2020/11/28

Abstract:

Background

Since the first successful facial transplantation in 2005, the benefits of this procedure in terms of aesthetics, functionality, and quality of life have been firmly established. However, despite immunosuppressive treatment, long-term survival of the allograft might be compromised by chronic antibody-mediated rejection (CAMR), leading to irreversible necrosis of the tissue. In the absence of therapeutic options, this complication is inevitably life-threatening.

Methods

We report facial retransplantation in a man, 8 years after his first facial transplantation because of extensive disfigurement from type 1 neurofibromatosis and 6 weeks after complete loss of his allograft due to severe CAMR. We describe the chronology of immune-related problems that culminated in allograft necrosis and the eventual loss of the facial transplant, the desensitisation protocol used for this highly immunosensitised recipient, the surgical technicalities of the procedure, the specific psychological management of this patient, and the results from follow-up at 30 months.

Findings

Although the patient had a complicated postoperative course with numerous immunological, infectious, cardiorespiratory, and psychological events, he was discharged after a hospital stay of almost 1 year. He has since been able to re-integrate into his community with acceptable restoration of his quality of life.

Interpretation

This clinical report of the first documented human facial retransplantation is proof-of-concept that the loss of a facial transplant after CAMR can be mitigated successfully by retransplantation combined with an aggressive desensitisation process.

DOI: 10.1016/S0140-6736(20)32438-7

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32438-7/fulltext

期刊信息

LANCET:《柳叶刀》,创刊于1823年。隶属于爱思唯尔出版社,最新IF:59.102
官方网址:http://www.thelancet.com/
投稿链接:http://ees.elsevier.com/thelancet

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