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Volume Depletion Of Face Transplants: Aging Or Rejection?
Maximilian Kueckelhaus, MD1, Marvee Turk, BS1, Kanako Kumamaru, MD, PhD2, Luccie Wo, MSE1, Ericka M. Bueno, PhD1, Christine G. Lian, MD3, Sebastian Fischer, MD1, Muayyad Alhefzi, MD1, Mario A. Aycart, MD1, Alexander Dermietzel, BS1, George F. Murphy, MD3, Frank J. Rybicki, MD, PhD2, Bohdan Pomahac, MD1.
1Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA, 2Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA, 3Division of Dermatopathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

Purpose: Thirty face transplants have been performed worldwide. Tissue atrophy can occur in the context of chronic rejection in solid organ transplantation and ultimately lead to graft failure. It remains unknown whether this may also be a challenge to vascularized composite allotransplantation. During routine follow-up of three face transplant recipients, volume loss in the allograft was noted in the absence of significant changes in patients’ weight. Routine allograft skin biopsies obtained at matching time points did not reveal extensive epidermal atrophy or significant loss of epidermal thickness.
Methods: Three-dimensional reconstructions of the allografts using computed tomography angiography (CTA) data were obtained and volume measurements of various facial allograft tissue compartments following CT scan segmentation were performed.
Results: Three-dimensional reconstructions showed a significant volume loss over time. CT scan segmentation revealed a significant loss of bone (mean 17.2%, p<0.05) between six and eighteen months after transplantation and non-fat soft tissue (mean 25.6%, p<0.01) between six months and three years after transplantation, whereas the fat volume remained constant.
Conclusions: Our study suggests that significant loss of allograft volume is likely related to muscle atrophy, and loss of bone tissue despite preservation of dentition. These findings are not comparable to volumetric changes in the face attributed to normal aging. Further studies need to be performed in order to rule out effects of chronic rejection on volume loss.


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