The world's first face transplant recipient is pushing her luck by smoking, doctors said. Smoking not only impairs circulation to the surgically transplanted tissues but also increases the risk of rejection, they explained.
The 38-year old French woman had undergone a complex yet successful face reconstructive surgery on November 27 in France after her face was badly mauled by her pet Labrador last spring. A new nose, chin and lips were taken from a brain-dead donor and transplanted onto her partially disfigured face. She responded very well to the treatment making the team of doctors hope for more such operations very soon.
However, three weeks after the surgery, her facial skin started turning red indicating infection. A biopsy revealed it was only her immune system trying to destroy the transplanted tissues. Doctors managed to get her back to normal with heavy doses of steroid drugs. But their hopes crashed recently after they learnt that she had started smoking.
They worry that smoking might interfere with the healing process and is particularly risky for her lips. They also worry that the operation which was acknowledged as a major achievement in reconstructive surgery might now provoke detractors into criticizing the whole effort.
It would be a pity, they said, that a major medical achievement which can give a new lease of life to people with disfigured faces, will now be doubted only because of this patient's non-compliance. “It is a problem”, agrees Dr Jean-Michel Dubernard, the chief surgeon who performed the complex operation in November.
Reconstructive surgeries are usually accompanied by many risks, especially of tissue or organ rejection. After any transplant operation the immune system tries to destroy the transplanted tissue because the white blood cells fail to recognise them in a process knows as major histocompatibility complex (MHC).
It is for this reason that doctors perform an MHC test on potential donors to determine the chances of a good match. Even after they find a good match, the patient still has to take immunosuppresants all life long in order to prevent rejection. But such prolonged use of such medicines raises the risk of damage to the liver and kidney.
The team of French doctors who performed the surgery made a presentation at a medical conference in the US this week. American doctors said they should stop debating on the ethical issues surrounding the operation and to start making such surgeries widely available to people who need them.
In the past the only other successful reconstructive surgeries have been hand transplants.
