A military veteran in America, who received the world’s first whole-eye transplant and partial face transplant, has made significant progress a year later and has been able to resume his normal life, his medical team and researchers say.
Aaron James (46) lost most of his face in an accident in 2021 while working as a high-voltage utility lineman, reports the BBC. He lost his dominant left arm, left eye, chin and nose, and for two years, was unable to eat solid food, taste, smell or talk normally.
His donor eye has so far maintained normal pressure and blood flow and retained its size, unlike donor eyes in animals that often shrink after transplants, researchers at NYU Langone Health said in a recent study, published in JAMA Network.
James has not regained sight in that eye, but researchers are hopeful he might eventually be able to see out of it again.
“The outcomes after this procedure are quite incredible and could pave the way for new clinical protocols and inspire further research into complex transplants involving critical sensory organs,” said Dr Vaidehi Dedania, the ophthalmologist who attended to James.
The study authors said a test called electroretinography, which measures the retina’s electrical response to light, showed that the donor eye’s rods and cones, the light-sensitive nerve cells in the eye, survived the transplant.
“This electrical response converts light into signals that ultimately the brain could interpret for vision, giving hope for the future of whole-eye transplants with an aim to restore sight,” the researchers said.
James did not lose sight in his right eye. Last May, he underwent 21 hours of surgery involving more than 140 healthcare professionals.
The donated face and eye came from a single male donor in his 30s. During the surgery, doctors injected adult stem cells from the donor’s bone marrow into the optic nerve to encourage its repair.
Researchers said James had since passed many major milestones, including eating solid foods and being able to smell again.
The military veteran is only the 19th person in the US to undergo a face transplant and the first person in the world to receive an entire human eye transplant.
Whole-eye transplant surgeries pose a host of challenges because of the complex structure and functions of the organ.
Researchers are now focused on using the James transplant to understand how to restore sight to the eye, said Dr Eduardo Rodriguez, a senior author of the study and the director of the Face Transplant Programme at NYU.
Study details
Combined Whole Eye and Face Transplant Microsurgical Strategy and 1-Year Clinical Course
Daniel Ceradini, Vaidehi Dedania, Bruce Gelb, et al.
Published in JAMA on 9 September 2024
Abstract
Importance
Catastrophic facial injury with globe loss remains a formidable clinical problem with no previous reports of reconstruction by whole eye or combined whole eye and facial transplant.
Objective
To develop a microsurgical strategy for combined whole eye and facial transplant and describe the clinical findings during the first year following transplant.
Design, Setting, and Participant
A 46-year-old man who sustained a high-voltage electrical injury with catastrophic tissue loss to his face and left globe underwent combined whole eye and face transplant using personalised surgical devices and a novel microsurgical strategy at a specialised centre for vascularised composite allotransplantation.
Main Outcomes and Measures
Reperfusion and viability of the whole eye and facial allografts, retinal function, and incidence of acute rejection.
Results
The patient underwent a combined whole eye and face transplant from an immunologically compatible donor with primary optic nerve coaptation and conventional postoperative immunosuppression. Globe and retinal perfusion were maintained throughout the immediate postoperative period, evidenced by fluorescein angiography. Optical coherence tomography demonstrated atrophy of inner retinal layers and attenuation and disruption of the ellipsoid zone. Serial electroretinography confirmed retinal responses to light in the transplanted eye. Using structural and functional magnetic resonance imaging, the integrity of the transplanted visual pathways and potential occipital cortical response to light stimulation of the transplanted eye was demonstrated. At 1 year post transplant (postoperative day 366), there was no perception of light in the transplanted eye.
Conclusions and Relevance
This is the first report of whole eye transplant combined with facial transplant, demonstrating allograft survival including rejection-free graft survival and electroretinographic measurements indicating retinal response to light stimuli. These data highlight the potential for clinical allotransplantation for globe loss.
See more from MedicalBrief archives:
World’s first human eyeball transplant
Five-year outcomes for face transplant recipients
Novel alternative to transplantation to treat corneal perforations