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Health See other Health Articles Title: Muscle and Bone Atrophy Follow Facial Transplantation Medscape... NEW YORK (Reuters Health) - Significant muscle and bone atrophy occur in the first three years after facial transplantation, resulting an appearance transformation that resembles accelerated aging, according to a new report. More than 30 individuals have undergone facial allotransplantation to restore normal anatomy to severely disfigured faces, researchers say, but long-term outcome data remain scarce. Dr. Bohdan Pomahac from Brigham and Women's Hospital, Harvard Medical School, Boston, and colleagues report their investigation of morphological and volumetric changes in three full-face transplants in the American Journal of Transplantation, online December 3. At six months after transplantation, skin appeared clinically normal, but by 18 months, there was an appreciable decrease in cheek fullness and irregularities in skin texture. At 36 months, there was a further decrease in skin turgor and fullness along with a dull and uneven skin tone. Patients showed steady improvements in muscle function over the 36 months after facial transplantation. Total graft volume decreased by 6.1% from six to 18 months after transplant, and by another 11.5% between 18 and 36 months. During these intervals, allograft bone volume decreased by 17.2% and 4.24%, respectively, and nonfat soft tissue volume decreased by 10.1% and 15.5%. Fat tissue volume did not change significantly during follow-up, the team reports. Soft-tissue thickness measurements decreased significantly after transplantation, and muscle biopsy at 36 months showed atrophic changes, but there were no significant decreases in epidermal thickness and/or collagen or fat content. Two patients showed complete bony union at 36 months, while one patient showed fused bone only on one side. All three transplant recipients experienced acute rejection episodes during the first 36 months, which may have contributed to muscle-volume loss. "This study illustrates how facial allografts are subject to substantial transformation in the initial 3 years after transplant," the authors conclude. "We demonstrate that although these changes imitate aging, they differ from the mechanisms of normal facial aging in that there is neither volume loss in the facial fat compartments nor consistent skin atrophy with loss of epidermal thickness." "These findings may have implications for risk-benefit assessment and donor selection for facial allograft transplantation and for potential standard secondary procedures after transplantation," they note. "Countermeasures to reverse, delay or even prevent muscle and bone atrophy in facial allotransplants will help improve outcomes in the future. Superior long-term outcomes of facial allotransplantation will be the crucial factor to advance toward clinical routine." Dr. Andres Rodriguez from Uppsala University Hospital in Sweden, who has reported on full-face transplantation techniques but was not part of the new work, told Reuters Health by email that "this paper reflects that the transplanted facial tissue develops over time and to see the final result, both in aesthetic and function, one needs to wait at least 2 years after transplantation and eventually some small surgical corrections may be necessary to improve the result." "This report outlines the complexity of face transplantation, and the evaluation of the outcomes, differently from other solid organ transplants, are based both in functionality and appearance and this can change over time," Dr. Rodriguez concluded. "This pioneering work also points out how further research and evaluations are needed to manage the changes in volume in the face in order to improve the outcomes." Dr. Pomahac did not respond to a request for comment. SOURCE: bit.ly/1SPGDDv Am J Transplant 2015. Latest in Transplantation Death Rates Down for Many, Hit Record Low for US Infants Favorable Long-Term Renal Graft Survival in Primary Glomerulonephritis UNOS Approves Child Priority Policy for Lung Transplant Readers Name Biggest Medical Stories of 2015 Closed-Loop Artificial Pancreas Maintains Euglycemia After Islet Autotransplantation Post Comment Private Reply Ignore Thread
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