Evolution of face transplant: an argument for a national donor registry

Leveraging Artificial Intelligence to Assess Perceived Age and Donor Facial Resemblance After Face Transplantation

PURPOSE

A major concern for patients undergoing facial transplantation relates to postoperative appearance. This study leverages artificial intelligence (AI) visual analysis software to provide an objective assessment of perceived age and degree of resemblance to the donor.

METHODS

Postoperative images of 15 face transplant patients were analyzed by Visage Technologies Visage|SDK™ AI facial analysis software to determine perceived age. A subgroup of eight face transplant patients, for which donor and patient pretrauma photographs were available, was analyzed using the same software to determine the percent similarity match to the patients' postoperative image. Mann-Whitney and Wilcoxon rank sum tests were utilized to evaluate for perceived age and facial recognition matching percentage, respectively.

RESULTS

AI perceived age was significantly more similar to the patient age (±3.5 years) than the donor age (±9.5, P = 0.0188). For facial resemblance, patients had a significantly higher average percent similarity match to their donor's face compared to their pretrauma native face (63% vs 57%, P = 0.0391).

CONCLUSIONS

Although patients more closely resembled their donor's resemblance posttransplantation, their perceived age correlated more significantly with their actual age than their donor allograft age. The findings of this study provide a helpful framework for counseling prospective patients on their expected appearance postoperatively.

Urinary bladder transplantation in humans - current status and future perspectives

Urinary bladder vascularized allograft transplantation in humans is currently extensively being investigated worldwide, owing to the theoretical potential of this approach as a therapeutic option for individuals with end-stage, non-oncological bladder conditions or congenital bladder pathologies. To date, a successful attempt at urinary bladder autotransplantation was carried out in a heart-beating brain-dead research human donor. The robot-assisted surgical technique was shown to be optimal for performing this procedure, achieving a good performance in terms of both bladder allograft collection as well as vascular, ureterovesical and vesicourethral anastomoses. The urinary bladder vascularized allograft would be an alternative to traditional urinary diversion methods that rely on the use of intestinal segments, potentially avoiding adverse effects associated with these approaches. However, different from ileal urinary diversion, bladder transplantation would require lifelong immune suppression. Clinical trials are in progress to assess the vascularized bladder allograft transplantation technique, as well as the safety of this procedure in oncological and non-oncological indications.

Vascularized Composite Allografts: Procurement, Allocation, and Implementation

Vascularized composite allotransplantation is a continuously evolving area of modern transplant medicine. Recently, vascularized composite allografts (VCAs) have been formally classified as 'organs'. In this review, key aspects of VCA procurement are discussed, with a special focus on interaction with the procurement of classical solid organs. In addition, options for a matching and allocation system that ensures VCA donor organs are allocated to the best-suited recipients are looked at. Finally, the different steps needed to promote VCA transplantation in society in general and in the medical community in particular are highlighted.