A 46-year-old military veteran is the first-ever recipient of a combined whole-eye and partial face transplant, according to clinicians at NYU Langone Health.
Last May, a team of more than 140 healthcare professionals — led by Eduardo Rodriguez, MD, DDS, director of the institution’s face transplant program — worked for 21 hours to complete the transplant, which was announced during a press conference on Wednesday.
“Working with an eye or transplanting the eye — we’re crossing into the central nervous system, we’re connecting the optic nerve in proximity to the brain. So the possibility of infection, meningitis, and death all exist,” Rodriguez said during the briefing.
Another novelty was that the procedure involved injecting bone marrow-derived adult stem cells from the donor into the optic nerve in hopes of nerve regeneration, the researchers said. It’s still not known whether the recipient, Aaron James, will ever regain his sight, however.
“We’ll see how it goes with the eye, but I think that could offer new breakthroughs to some potential treatments in central nervous system injury,” Rodriguez said.
Bohdan Pomahac, MD, head of plastic surgery at Yale School of Medicine in New Haven, Connecticut, who was not involved with the transplant, told MedPage Today that he does not think James’ new eye will ever be functional, but he noted the surgery is an important precedent for figuring out how to regenerate the optic nerve.
“This would be an example of how you push the boundary of our understanding of anatomy and what can be surgically done,” Pomahac said. “In this case of Dr. Rodriguez, it’s certainly a new technique that he developed and utilized for this particular special case of transplant.”
James, a high-voltage lineman, lost his left eye, nose, lips, front teeth, left cheek, and part of his chin, as well as his left arm, from extensive burns after accidentally touching a live wire in 2021. He needed a tracheostomy to breathe and a feeding tube to eat.
Prior to his transplant, James wore an eye patch and face mask all the time to hide the drastic facial injuries he sustained. Now, he no longer feels the need to wear them.
“I kind of like everybody seeing me now,” James said at the press conference. He also thanked the donor’s family for making his new life possible.
Pomahac said face transplants are reserved for people with devastating facial injuries, often from burns or animal attacks. He said the procedure “typically involves the central part of a face — the areas that are so anatomically unique that you cannot reconstruct them using conventional methods or the outcomes are horribly suboptimal.”
One year after the incident, Rodriguez conducted an initial evaluation to determine whether James was a good fit for a face transplant. By February 2023, James was officially on the United Network for Organ Sharing (UNOS) list waiting for the right donor candidate.
LiveOnNY, which does organ procurement in the New York metropolitan area, led a local search, and just 3 months later found a potential donor in a young man in his 30s. Vaidehi Dedania, MD, a retina specialist at NYU Langone, confirmed the donor eye was healthy and viable, and the donor was confirmed.
Pomahac noted that age, sex, and skin complexion matches are considered for viable face transplant matches.
The 21-hour surgery took place in two operating rooms consecutively — one for James, and one for the donor. Incisions were made using 3D printed cutting guides that were specific to James and the donor.
In total, the transplant involved the whole eye and socket, including the orbital bones and surrounding tissue and optic nerve. The partial face transplant included the nose, eyelids, eyebrow, lips, and underlying skull, cheek, nasal and chin bones, tissues, muscles, blood vessels, and nerves.
Additionally, bone marrow was harvested from the donor’s spinal cord for CD34+ stem cells, which were injected into James’ optic nerve connection.
Samer Al-Homsi, MD, MBA, executive director of the transplantation and cellular therapy center at NYU Langone Health, said this was “the first attempt of injecting adult stem cells into a human optic nerve during a transplant in the hopes of enhancing nerve regeneration.”
“We chose to use CD34 positive stem cells which have been shown to harbor the potential to replace damaged cells and neuroprotective properties,” he explained.
Post-surgery, James recovered in the ICU for 17 days before being discharged to a nearby apartment for a few months of outpatient speech, occupational, and physical therapy. In September, James finally returned home to his family in Arkansas, able to taste, smell, and eat again.