Six years ago, Carmen Blandin Tarleton became one of the first U.S. patients to receive a face transplant after she was severely burned in a domestic violence attack, but doctors at Brigham and Women's Hospital recently discovered underlying tissue damage is causing the transplant to fail, highlighting a fallibility of the cutting-edge technique, Liz Kowalczyk reports for the Boston Globe.

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Background on face transplants

Face transplants have been performed on more than 44 patients around the world, including 15 patients in the United States. Brigham and Women's Hospital in Massachusetts has performed nine face transplants, which is the most of any other medical center in the United States, according to Kowalczyk.

So far, no U.S. patients have had to give up their donor faces, Kowalczyk reports. However, a male patient in France last year received a second transplant after his body rejected his original donor face eight years after transplant.

Brian Gastman, a transplant surgeon at the Cleveland Clinic, where the first U.S. face transplant was performed 11 years ago, noted that more patients are starting to experience chronic rejection. "We all believe every patient will likely need a retransplant" at some point, he said

Tarleton's story

In 2007, Tarleton was "burned beyond recognition" when her estranged husband beat her and doused her body with lye, leaving her with burns over 80% of her body, Kowalczyk writes.

After the attack, Tarleton was flown to Brigham and Women's where she underwent 38 surgeries over three months. During that time, Tarleton received multiple blood transfusions to recover, which made her immune system extremely potent, ready to attack foreign cells with more aggression than before, Kowalczyk writes.

When Tarleton was being considered for a potential face transplant, doctors at Brigham and Women's knew the operation could be a failure and that her body might reject the donor face, according to Kowalczyk.

Still, in 2013, doctors decided to go through with the operation and transplanted a donor's facial and neck skin, as well as nose, lips, arteries, muscles, and nerves onto Tarleton.

However, the doctor's concerns came to light. Just five days after the transplant, Tarleton's donor face began to swell. Doctors spent a month trying different drugs and a "dialysis-like procedure," Kowalczyk writes. When a doctor spoke to Tarleton about the possibility of giving up the face, she decided instead to try a "dangerous medication that would nearly shut down [her] immune system for one to two months," Kowalczyk writes. It was successful, and Tarleton kept the face.

But last month, about six years after the initial transplant, Tarleton started experiencing new rejection symptoms, including face swelling and blisters along the edges of the transplant on her neck and ears.

When doctors examined samples of Tarleton's skin and tissue, they discovered that she had underlying tissue damage that caused blood vessels in her face to close, which caused her facial tissue to die. Doctors said the issue likely means Tarleton will lose the donor face.

The possibility of a second transplant

Now, doctors at Brigham and Women's are evaluating Tarleton for a second transplant.

If the rejection progresses slowly, the hospital will approve Tarleton for another transplant, which means she'll go back on the waiting list for a new donor. According to Tarleton, the worst-case scenario for her would be that the facial tissue would die too quickly for a transplant, meaning the doctors would have to remove the donor tissue and reconstruct Tarleton's original face without a transplant, which would leave her "severely disfigured," according to Kowalczyk.

Tarleton said she was surprised by the news, but has "no regrets" about receiving her first transplant, adding that since the transplant she's been able to live with significantly less pain.

What this means for face transplants

Tarleton's doctors said that most transplant organs have a limited lifespan, but noted that Tarleton's experience serves as a reminder that face transplants are still "a young science with many unanswered questions about benefits versus long-term risks," Kowalczyk writes.

For instance, some transplant participants experience infections after the operation or side effects of the drugs they have to take to suppress their immune systems. And still, doctors do not know how long face transplants can last (Kowalczyk, Boston Globe, 9/20).