Full Facial Retransplantation in a Female Patient - Technical, Immunologic and Clinical Considerations.

There is limited experience with facial re-transplantation (fRT). We report on the management of facial re-transplantation in a facial vascularized composite allotransplant recipient following irreversible allograft loss 88 months after the first transplant. Chronic antibody mediated rejection and recurrent cellular rejection resulted in a deteriorated first allograft and the patient underwent retransplantation. We summarize the events between the two transplantations, focusing on the final rejection episode. We describe the surgical technique of facial re-transplantation, the immunological and psychosocial management, and the six-month post-operative outcomes. Removal of the old allograft and inset of the new transplant were done in one operation. The donor and recipient were a good immunological match. The procedure was technically complex, requiring more proximal arterial anastomoses and an interposition vein graft. During the first and second transplantation the facial nerve was coapted at the level of the branches. There was no hyperacute rejection in the immediate postoperative phase. Outcomes six months postoperatively are promising. We provide proof-of-concept that facial re-transplantation is a viable option for patients who suffer irreversible facial vascularized composite allograft loss.