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Van Dieren L, Tawa P, Coppens M, Naenen L, Dogan O, Quisenaerts T, Lancia HH, Oubari H, Dabi Y, De Fré M, Thiessen Ef F, Cetrulo CL, Lellouch AG. Acute Rejection Rates in Vascularized Composite Allografts: A Systematic Review of Case Reports. J Surg Res 2024; 298:137-148. [PMID: 38603944 DOI: 10.1016/j.jss.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/20/2024] [Accepted: 02/29/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION Vascularized Composite Allografts (VCA) are usually performed in a full major histocompatibility complex mismatch setting, with a risk of acute rejection depending on factors such as the type of immunosuppression therapy and the quality of graft preservation. In this systematic review, we present the different immunosuppression protocols used in VCA and point out relationships between acute rejection rates and possible factors that might influence it. METHODS This systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We systematically searched Medline (PubMed), Embase, and The Cochrane Library between November 2022 and February 2023, using following Mesh Terms: Transplant, Transplantation, Hand, Face, Uterus, Penis, Abdominal Wall, Larynx, and Composite Tissue Allografts. All VCA case reports and reviews describing multiple case reports were included. RESULTS We discovered 211 VCA cases reported. The preferred treatment was a combination of antithymocyte globulins, mycophenolate mofetil (MMF), tacrolimus, and steroids; and a combination of MMF, tacrolimus, and steroids for induction and maintenance treatment, respectively. Burn patients showed a higher acute rejection rate (P = 0.073) and were administered higher MMF doses (P = 0.020). CONCLUSIONS In contrast to previous statements, the field of VCA is not rapidly evolving, as it has encountered challenges in addressing immune-related concerns. This is highlighted by the absence of a standardized immunosuppression regimen. Consequently, more substantial data are required to draw more conclusive results regarding the immunogenicity of VCAs and the potential superiority of one immunosuppressive treatment over another. Future efforts should be made to report the VCA surgeries comprehensively, and muti-institutional long-term prospective follow-up studies should be performed to compare the number of acute rejections with influencing factors.
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Affiliation(s)
- Loïc Van Dieren
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Faculty of Medicine and Health Sciences, Antwerp, Belgium; Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Pierre Tawa
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, Massachusetts; Shriners Hospitals for Children-Boston, Boston, Massachusetts
| | - Marie Coppens
- Faculty of Medicine and Health Sciences, Antwerp, Belgium
| | - Laura Naenen
- Faculty of Medicine and Health Sciences, Antwerp, Belgium
| | - Omer Dogan
- Faculty of Medicine and Health Sciences, Antwerp, Belgium
| | | | - Hyshem H Lancia
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Haïzam Oubari
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Yohann Dabi
- Department of Obstetrics, Gynecology and Reproductive Medicine, Sorbonne University, Tenon Hospital (AP-HP), Paris, France
| | - Maxime De Fré
- Department of Plastic, Reconstructive and Aesthetic Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Filip Thiessen Ef
- Department of Plastic, Reconstructive and Aesthetic Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Curtis L Cetrulo
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, Massachusetts; Shriners Hospitals for Children-Boston, Boston, Massachusetts
| | - Alexandre G Lellouch
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, Massachusetts; Shriners Hospitals for Children-Boston, Boston, Massachusetts.
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Longo B, Alberti FB, Pomahac B, Pribaz JJ, Meningaud JP, Lengelé B, Özkan Ö, Özkan Ö, Barret JP, Lassus P, Blondeel P, Roche N, Gurunian R, Infante-Cossio P, Lindford A, Brandacher G, Giovanoli P, Plock J, Gorantla VS, Herrington ER, Saleh D, Natalwala I, Cardillo M, Jowsey-Gregoire S, La Padula S, Manas D, Benedict J, Nuccitelli G, Bosc R, Morello R, Farías-Yapur A, Giacalone M, Hall S, D'Orsi G, Cervelli V. International consensus recommendations on face transplantation: A 2-step Delphi study. Am J Transplant 2024; 24:104-114. [PMID: 37666457 PMCID: PMC10881406 DOI: 10.1016/j.ajt.2023.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/03/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023]
Abstract
Face transplantation is a viable reconstructive approach for severe craniofacial defects. Despite the evolution witnessed in the field, ethical aspects, clinical and psychosocial implications, public perception, and economic sustainability remain the subject of debate and unanswered questions. Furthermore, poor data reporting and sharing, the absence of standardized metrics for outcome evaluation, and the lack of consensus definitions of success and failure have hampered the development of a "transplantation culture" on a global scale. We completed a 2-round online modified Delphi process with 35 international face transplant stakeholders, including surgeons, clinicians, psychologists, psychiatrists, ethicists, policymakers, and researchers, with a representation of 10 of the 19 face transplant teams that had already performed the procedure and 73% of face transplants. Themes addressed included patient assessment and selection, indications, social support networks, clinical framework, surgical considerations, data on patient progress and outcomes, definitions of success and failure, public image and perception, and financial sustainability. The presented recommendations are the product of a shared commitment of face transplant teams to foster the development of face transplantation and are aimed at providing a gold standard of practice and policy.
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Affiliation(s)
- Benedetto Longo
- Chair of Plastic Surgery, Department of Surgical Sciences, Tor Vergata University of Rome, Rome, Italy.
| | - Fay Bound Alberti
- Director of Interface and Director of the Centre for Technology and the Body, King's College London
| | - Bohdan Pomahac
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Julian Joseph Pribaz
- Department of Plastic and Reconstructive Surgery, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Jean-Paul Meningaud
- Department of Plastic, Reconstructive, and Maxillofacial Surgery, Henri Mondor Hospital, University of Paris, Créteil, France
| | - Benoît Lengelé
- Department of Plastic and Reconstructive Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Ömer Özkan
- Department of Plastic and Reconstructive Surgery, Akdeniz University School of Medicine, Antalya, Turkey
| | - Özlenen Özkan
- Department of Plastic and Reconstructive Surgery, Akdeniz University School of Medicine, Antalya, Turkey
| | - Juan Pere Barret
- Department of Plastic Surgery and Burns, Vall d'Hebron Barcelona Hospital Campus, Universidad Autònoma de Barcelona, Barcelona, Spain
| | - Patrik Lassus
- Department of Plastic Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Phillip Blondeel
- Department of Plastic and Reconstructive Surgery, Ghent University Hospital, Ghent, Belgium
| | - Nathalie Roche
- Department of Plastic and Reconstructive Surgery, Ghent University Hospital, Ghent, Belgium
| | - Raffi Gurunian
- Department of Plastic Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Pedro Infante-Cossio
- Department of Oral and Maxillofacial Surgery, Virgen del Rocio University Hospital, University of Seville, Seville, Spain
| | - Andrew Lindford
- Department of Plastic Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Gerald Brandacher
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Pietro Giovanoli
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Jan Plock
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Vijay S Gorantla
- Department of Surgery, Wake Forest School of Medicine, Wake Forest Institute of Regenerative Medicine, Winston Salem, North Carolina, USA
| | | | - Daniel Saleh
- Department of Plastic and Reconstructive Surgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Massimo Cardillo
- Director of National Transplants Center, National Institute of Health, Italian Ministry of Health, Rome, Italy
| | | | - Simone La Padula
- Department of Plastic, Reconstructive, and Maxillofacial Surgery, Henri Mondor Hospital, University of Paris, Créteil, France; Department of Plastic and Reconstructive Surgery, Università degli Studi di Napoli Federico II, Napoli, Italy
| | - Derek Manas
- NHS Blood and Transplant, Stoke Gifford, Bristol, UK; Liver Transplant Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle University, Newcastle, UK
| | - James Benedict
- Center for Global Health Ethics, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Gloria Nuccitelli
- Division of Anesthesia and Intensive Care Medicine, Department of Clinical and Surgical Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Romain Bosc
- Department of Plastic, Reconstructive, and Maxillofacial Surgery, Henri Mondor Hospital, University of Paris, Créteil, France
| | - Roberto Morello
- Department of Maxillofacial Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Anneke Farías-Yapur
- School of Psychology, Universidad Panamericana, Benito Juárez, Mexico City, Mexico
| | - Martina Giacalone
- Chair of Plastic Surgery, Department of Surgical Sciences, Tor Vergata University of Rome, Rome, Italy
| | | | - Gennaro D'Orsi
- Chair of Plastic Surgery, Department of Surgical Sciences, Tor Vergata University of Rome, Rome, Italy
| | - Valerio Cervelli
- Chair of Plastic Surgery, Department of Surgical Sciences, Tor Vergata University of Rome, Rome, Italy
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Longo B, Pomahac B, Giacalone M, Cardillo M, Cervelli V. 18 years of face transplantation: Adverse outcomes and challenges. J Plast Reconstr Aesthet Surg 2023; 87:187-199. [PMID: 37879143 DOI: 10.1016/j.bjps.2023.09.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 08/19/2023] [Accepted: 09/12/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Since the first procedure performed in 2005, face transplantation has been debated as viable approach for the treatment of severe craniofacial defects. Despite the benefits provided, the experience in face allotransplantation has brought to light a significant risk of complications, including allograft removal or loss, and mortality. The present study is intended to provide an updated review on complications and major challenges witnessed over 18 years of experience in the field. METHODS A systematic review of PubMed, MEDLINE, Cochrane, Google, and Google Scholar databases on face transplantation was conducted according to PRISMA guidelines up to April 2023. Articles providing details on cases of face allograft loss, removal, and patient death were included. Online articles and media reports were assessed to include information not disclosed in peer-reviewed literature. Face transplant centers were contacted to have updated follow-up information on single-face transplant cases. RESULTS The search yielded 1006 reports, of which 28 were included. On a total of 48 procedures performed in 46 patients, adverse outcomes were gleaned in 14 cases (29%), including seven allograft losses (14.6%), and the death of ten patients (21.7%). Chronic rejection was the leading cause of allograft loss, with a median time from transplant to irreversible rejection of 90 months (IQR 88.5-102). The main causes of death were infectious complications, followed by malignancies, non-compliance to immunosuppression, and suicide. The median time to death was 48.5 months (IQR 19-122). CONCLUSIONS To the best of our knowledge, this is the first study providing a comprehensive review of adverse outcomes in face transplantation. Considering the high rate of major complications, the heterogeneity of cases and single-center approaches, and the absence of published standards of care, the development of a consensus by face transplant teams holds the key to the field's advancement.
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Affiliation(s)
- Benedetto Longo
- Chair of Plastic and Reconstructive Surgery, Department of Surgical Sciences, Tor Vergata University of Rome, Rome, Italy.
| | - Bohdan Pomahac
- Division of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Martina Giacalone
- Chair of Plastic and Reconstructive Surgery, Department of Surgical Sciences, Tor Vergata University of Rome, Rome, Italy
| | - Massimo Cardillo
- National Transplants Center, National Institute of Health, Italian Ministry of Health, Rome, Italy
| | - Valerio Cervelli
- Chair of Plastic and Reconstructive Surgery, Department of Surgical Sciences, Tor Vergata University of Rome, Rome, Italy
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Longo B, Curigliano G, Cervelli V. Comment on "Reply: Comment on BIA-ALCL: Comparing the Risk Profiles of Smooth and Textured Breast Implants". Aesthetic Plast Surg 2023:10.1007/s00266-023-03556-z. [PMID: 37610519 DOI: 10.1007/s00266-023-03556-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/30/2023] [Indexed: 08/24/2023]
Affiliation(s)
- Benedetto Longo
- Chair of Plastic Surgery, Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Via Montpellier, 1 - 00133, Rome, Italy.
| | - Giuseppe Curigliano
- Division of Early Drug Development for Innovative Therapies, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Haemato-Oncology, University of Milano, Milan, Italy
- Group of Experts on BIA-ALCL, The Italian Ministry of Health, Rome, Italy
| | - Valerio Cervelli
- Chair of Plastic Surgery, Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Via Montpellier, 1 - 00133, Rome, Italy
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La Padula S, Pensato R, Pizza C, Coiante E, Roccaro G, Longo B, D’Andrea F, Wirz FS, Hersant B, Meningaud JP. Face Transplant: Indications, Outcomes, and Ethical Issues-Where Do We Stand? J Clin Med 2022; 11:jcm11195750. [PMID: 36233619 PMCID: PMC9571096 DOI: 10.3390/jcm11195750] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/13/2022] [Accepted: 09/26/2022] [Indexed: 11/21/2022] Open
Abstract
Background: The addition of face allotransplantation (FT) to the head and neck reconstructive surgery arsenal has started a true revolution. This study is aimed at providing an extensive analysis of the current practice of composite tissue allotransplantation. Moreover, a thorough description of pre-procedural, intra-operative, and post-procedural settings, indications, contraindications, outcomes, ethical considerations, and future perspectives is provided. Methods: The authors’ experience was supplemented with a literature review performed by using the PubMed, MEDLINE, and Embase databases on 21 February 2022. The search terms used were “face transplantation indications”, “face transplantation complications”, and “face transplantation ethical issues”. Results: The most recent achievements and long-term clinical sequelae of FT are classified and summarized. A large number of records (4435) were identified. Seventy-five articles were assessed for eligibility. Publications without new data and reports with a patient follow-up < 5 years were excluded. Nineteen articles met the criteria for inclusion. Conclusions: The most recent achievements in the field of FT may be combined with cutting-edge regenerative medicine procedures and innovative immunological processing. It is paramount to build strong international networks between the world FT experts in order to achieve higher-level outcomes and reduce the complication rate. Nevertheless, the utmost caution is required in patient selection, clinical assessment, strict follow-up, and rejection management.
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Affiliation(s)
- Simone La Padula
- Department of Plastic and Reconstructive Surgery, Università degli Studi di Napoli Federico II, Via Pansini 5, 80131 Napoli, Italy
- Department of Plastic, Reconstructive and Maxillo Facial Surgery, Henri Mondor Hospital, University Paris XII, 51 Avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
- Correspondence:
| | - Rosita Pensato
- Department of Plastic and Reconstructive Surgery, Università degli Studi di Napoli Federico II, Via Pansini 5, 80131 Napoli, Italy
| | - Chiara Pizza
- Department of Plastic, Reconstructive and Maxillo Facial Surgery, Henri Mondor Hospital, University Paris XII, 51 Avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Edoardo Coiante
- Department of Plastic, Reconstructive and Maxillo Facial Surgery, Henri Mondor Hospital, University Paris XII, 51 Avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Giovanni Roccaro
- Department of Plastic, Reconstructive and Maxillo Facial Surgery, Henri Mondor Hospital, University Paris XII, 51 Avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Benedetto Longo
- Department of Plastic and Reconstructive Surgery, Università di Roma Tor Vergata, Viale Oxford 81, 00133 Roma, Italy
| | - Francesco D’Andrea
- Department of Plastic and Reconstructive Surgery, Università degli Studi di Napoli Federico II, Via Pansini 5, 80131 Napoli, Italy
| | | | - Barbara Hersant
- Department of Plastic, Reconstructive and Maxillo Facial Surgery, Henri Mondor Hospital, University Paris XII, 51 Avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
| | - Jean Paul Meningaud
- Department of Plastic, Reconstructive and Maxillo Facial Surgery, Henri Mondor Hospital, University Paris XII, 51 Avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France
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Parker A, Chaya BF, Rodriguez-Colon R, Hao Y, Kurian K, Trilles J, Boczar D, Brydges H, Rodriguez ED. Recipient Selection Criteria for Facial Transplantation: A Systematic Review. Ann Plast Surg 2022; 89:105-112. [PMID: 35749814 DOI: 10.1097/sap.0000000000003255] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recipient selection is an important determinant of surgical outcomes in facial transplantation (FT). Appropriately, each FT program develops their own guidelines for recipient selection criteria. Currently, there is no resource to simultaneously assess and identify similarities and differences between these guidelines. Such information could be useful in distinguishing areas of FT that are well understood from those that could benefit from further exploration. METHODS We performed a systematic review of the scientific literature from inception to June 18, 2021, using Pubmed, Embase, Cochrane Library, and Scopus to identify articles pertaining to recipient selection criteria. Clinical trials were identified through the Clinicaltrials.gov registry. United States and international program websites were reviewed for patient-facing information. RESULTS Our systematic review yielded 90 suitable articles, 8 clinical trials, and 7 program websites containing the recipient selection criteria of 24 different FT programs. The most reported on recipient criteria were age, positive human immunodeficiency viral status (HIV+), positive hepatitis C viral status, psychosocial stability, and medical compliance. Other criteria were rarely addressed, such as blindness and recipient immune status. CONCLUSIONS Guidelines among different face transplant programs are changing over time. We found consensus on certain recipient selection criteria, but the majority remain program or surgeon dependent, emphasizing that FT is still an evolving procedure. Although most programs reported on their recipient selection criteria, the rationale was often missing. Further discussion about recipient selection criteria and the reasoning behind employing or changing them will help advance the field.
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Affiliation(s)
| | - Bachar F Chaya
- Hansjörg Wyss Department of Plastic Surgery, New York University, New York, NY
| | | | - Yvonne Hao
- From the New York University Grossman School of Medicine
| | - Keerthi Kurian
- California Northstate University, College of Medicine, Elk Grove, CA
| | - Jorge Trilles
- Hansjörg Wyss Department of Plastic Surgery, New York University, New York, NY
| | - Daniel Boczar
- Hansjörg Wyss Department of Plastic Surgery, New York University, New York, NY
| | - Hilliard Brydges
- Hansjörg Wyss Department of Plastic Surgery, New York University, New York, NY
| | - Eduardo D Rodriguez
- Hansjörg Wyss Department of Plastic Surgery, New York University, New York, NY
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Sipilä M, Kiukas EL, Lindford A, Ylä-Kotola T, Lauronen J, Sintonen H, Lassus P. The four category systematic approach for selecting patients for face transplantation. J Plast Surg Hand Surg 2021; 56:79-86. [PMID: 34255990 DOI: 10.1080/2000656x.2021.1933995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
There is a need for a systematic approach to evaluate patients for potential face transplantation (FT). Ten patients with severe facial defects treated between 1995 and 2017 formed the study group. Data was collected from patient charts and clinical, radiological and laboratory examinations. Facial deficiencies were subdivided into four different categories: anatomical region (10 facial subunits), facial function, aesthetic defect (range 0-9-worst), and impact on health-related quality of life (HRQoL) (15D questionnaire, range 0-1). Immunological status and possible contraindications were also evaluated. Defect aetiology consisted of burns (4), ballistic injury (3), blunt injury (1), blast injury (1), and neurofibromatosis type I (1). All patients had central facial deficiencies and 6 patients had 8 to 10 injured facial subunits. All patients had at least partial loss of facial function. The mean aesthetic disfigurement score was 6.4. The median lowering of 15D score was -0.107. None were significantly sensitized although four patients had relative contraindications and one patient had an absolute contraindication for FT. Three patients with a severe overall facial deficiency were considered as potential FT candidates. We herein propose a comprehensive and systematic tool to evaluate potential candidates for FT. This approach includes assessment of 4 key categories: anatomical regions affected, facial function, aesthetics, and HRQoL.
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Affiliation(s)
- Matias Sipilä
- Department of Plastic Surgery, Helsinki University Hospital University of Helsinki, Helsinki, Finland
| | - Emma-Lotta Kiukas
- Department of Plastic Surgery, Helsinki University Hospital University of Helsinki, Helsinki, Finland
| | - Andrew Lindford
- Department of Plastic Surgery, Helsinki University Hospital University of Helsinki, Helsinki, Finland
| | - Tuija Ylä-Kotola
- Department of Plastic Surgery, Helsinki University Hospital University of Helsinki, Helsinki, Finland
| | - Jouni Lauronen
- Finnish Red Cross Blood Service, Histocompatibility Laboratory, Helsinki, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Patrik Lassus
- Department of Plastic Surgery, Helsinki University Hospital University of Helsinki, Helsinki, Finland
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