Ten Year Follow-up After Face Transplantation - a Single Center Retrospective Cohort Study.

Face transplantation has emerged as reconstructive option for the most challenging facial deformities. A comprehensive analysis of functional outcomes, medical complications, incidence of malignancy, and chronic rejection in face transplantation recipients over an extended follow-up period has not yet been published leaving a notable gap in the literature. We retrospectively collected data of morbidity, rejection, vasculopathy, metabolic side effects, as well as functional outcome of sensory return, facial motor function, and speech from nine patients who underwent face transplantation at Brigham and Women´s Hospital (Boston, USA) between 2009 - 2020. The median follow-up was 120 months (54 - 154 months). Four grafts (40%) developed signs of clinical and histopathological chronic rejection without evidence of vasculopathy on computer tomography angiograms. Sensory return assessed with WEST-Monofilament showed an increase in six patients (66.7%) and facial expression analysis showed improvement throughout the whole cohort at their most recent follow up. Speech intelligibility was stable or increasing for five patients (55.6%). In conclusion, the long-term outcomes reveal promising results in terms of overall graft retention, and functional recovery. Metabolic, malignant, and infectious complications, as well as graft rejection episodes are expected to occur in this population, and some may be related to patient's age and lifestyle.