- The Washington Times - Tuesday, June 16, 2009

PARIS | A 30-year-old French burn victim who received the world’s first face and double-hand transplant died of cardiac arrest during a follow-up operation, hospital officials said Monday.

Surgeon Laurent Lantieri, who performed the groundbreaking transplant near Paris in April, said the patient had died June 8 during an operation to treat a “common” post-operative infection.

Horribly disfigured in an accident, the patient’s entire face above the lips, including the scalp, nose, ears and forehead, was replaced along with both his hands in a 30-hour operation beginning April 4 and involving a medical team of more than 40.

“He developed a facial infection a few weeks after his operation, and during an operation to try to tackle the infection he suffered cardiac arrest,” Dr. Lantieri told RTL radio.

The surgeon said that previous biopsies had shown the patient’s immune system was not rejecting the grafts, and it was hoped that a post-mortem examination would help determine why he suffered heart failure.

Jean-Paul Meningaud, another surgeon on the transplant team, said “the infection, probably combined with resistant germs, is the primary cause of his death.”

“But this death does not halt a research program that remains a wonderful source of hope for disfigured patients who have no other options,” he said.

The recipient had burn scars to the face and hands so severe that they had robbed him of all social life since 2004. He had been on a donor waiting list for more than a year.

The first ever successful face transplant was performed in France in 2005 on Isabelle Dinoire, a 38-year-old woman who had been mauled by her dog.

Worldwide, there have been seven face transplants to date - three others in France, all performed by Dr. Lantieri’s team, two in the United States and one in China, in which the recipient died after stopping his anti-rejection drugs.

This was the first time a transplant of both hands and the face had been completed in one go.

Dr. Lantieri’s first two patients both developed post-operative infections, but without serious consequences, according to Dr. Meningaud, who said “the risk of infection is higher among burn victims.”

With skin, hand and face transplants, fears that patients would reject the grafted tissues have led surgeons to prescribe high doses of immunosuppressant drugs - which in turn leaves patients more vulnerable to infection.

Dr. Meningaud said the latest case was likely to revive debate on striking a balance between stopping transplant recipients from rejecting a graft, and protecting them from infection - including possible changes to the way grafts are taken from donors.

“We may have overestimated the risk of rejection with this type of graft, relative to the risk of infection,” he said.

Dr. Meningaud said his team’s two other face transplant patients - 29-year-old tumor sufferer Pascale Coler, grafted in 2007, and an unnamed 28-year-old gunshot victim, operated on in March - were “very well.”


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