Woman who got face transplant battled tissue rejection, surgeon reveals

Wednesday, January 18th 2006, 6:10 am

By: News On 6

TUCSON, Ariz. (AP) _ French surgeons are declaring the world's first face transplant a success even as they revealed that the patient battled a serious tissue-rejection episode less than a month after her groundbreaking operation.

``We have plans for five new patients,'' said Dr. Jean-Michel Dubernard, a celebrity surgeon and politician from Lyon, France, who led the team of doctors.

Several of the surgeons spoke in interviews Tuesday before making their first scientific presentation of the case at a medical conference in Tucson. Two American doctors attending the conference said they were moving forward with plans to offer face transplants in the United States, though only after standard surgical remedies had already been tried.

``Our approach ... is to be sure that we are not violating the borders of patients not knowing what's good or bad for them'' in their desperation to look better, said Dr. Maria Siemionow, a Cleveland Clinic surgeon who is farthest along on such plans.

The French patient, a 38-year-old divorced mother of two teenage girls, received a new nose, chin and lips from a brain-dead donor on Nov. 27. She was severely disfigured last spring when her pet Labrador bit and scratched at her face while trying to wake her.

About three weeks after the operation, doctors noticed the transplanted skin turning red and suspected that she had an infection. But a biopsy showed the true culprit: her immune system actually was attacking and rejecting the new face.

They tried to treat her by increasing the dose of the steroid prednisone, an immune-suppressing drug. They even gave her a face cream and mouthwash containing the medication, but it didn't help.

On Dec. 30, doctors resorted to giving her huge doses of the steroid drug, and finally succeeded in halting the rejection episode on Jan. 2.

``She was alarmed'' at the prospect of losing her new face, but was relieved when it looked normal again after a few days, said Dr. Emmanuel Morelon, another of her physicians.

Since then, the woman has done so well that she can go out in a crowd without drawing lots of attention, as she did Sunday night with her psychiatrist, Dubernard said.

``They walked on the street, they went in a bar,'' Dubernard said. ``She can swallow and eat. That was impossible before the surgery. Psychologically, she's very happy.''

Dr. Benoit Lengele, another of her physicians from Brussels, Belgium, showed recent photographs of her with just a thin, ropelike red scar around the edges of the transplanted face.

Magnetic resonance imaging, or MRI, tests show that brain areas ``light up'' when her new face is lightly touched, ``the objective proof'' that she is regaining sensation, said Dr. Bernard Devauchelle, a surgeon at University Hospital of Amiens, France, who did a large share of the transplant operation.

It is too soon to say whether a second experimental procedure the woman received _ two infusions of whole bone marrow from the dead donor _ will help prevent rejection, as her doctors hope, or actually aggravate it by providing more foreign tissue for her body to attack.

Dubernard has been criticized for trying that, as well as for arranging for the woman to sell the rights to photographs of herself to a longtime friend of his. Dubernard insisted that he arranged the sale to keep others from taking advantage of her.

``I want to have this thing clear on this point,'' Dubernard said. ``We are doctors. We did it to aid the patient, not to make beaucoup,'' he said, rubbing his thumb and index finger together to mean money.

On Wednesday, the woman, identified only as Isabelle because of French privacy laws, plans to move back to Amiens from Lyon, where she has been receiving care.

American doctors, while stressing that they were not criticizing the French, said they would attempt a face transplant only as a last resort for a severely disfigured patient. Since last fall, Siemionow has been screening potential candidates _ burn and accident victims _ and said selecting one is ``a very difficult decision, more than I expected at the beginning.''

Since the French operation, dozens of hopeful patients have called the clinic.

``I don't want patients worrying about who will be first,'' she said.

Dr. Warren Breidenbach, the University of Louisville surgeon who did the first hand transplant in the U.S., in 1999, also is working on face transplant plans, as is another group of surgeons in Louisville.

``I'm very excited about this,'' he said. But expanding it to more patients requires more study on how to reduce the need for lifelong use of powerful anti-rejection drugs, which raise the risk of high blood pressure, cancer, kidney failure and other problems, he said.