Boston, MA — Carmen Blandin Tarleton, 52, became the first person in the U.S. and second in the world to receive a second face transplant, undergoing an approximately 20-hour surgery at Brigham and Women’s Hospital in July. The face transplant, involving a team of over 45 clinicians, led by Bohdan Pomahac, MD, is the 10th performed at the Brigham since 2011 and the 16th nationwide.
“I am grateful to the team at the Brigham and to my donor for making it possible to receive a second face transplant, and with it the opportunity to improve my quality of life,” said Tarleton. “The pain I was suffering is gone, and I look forward to resuming my work and inspirational speaking as soon as possible.”
Tarleton was listed for her second face transplant in October 2019 after the small vessels that supply blood to the face beneath the skin were injured over time as a result of chronic rejection of her first transplant. This led to scarring, tightness and associated pain. Tarleton’s first face transplant, in 2013, occurred when she suffered burns to over 80 percent of her body after a brutal attack by her estranged husband, who doused her with industrial strength lye.
“One can hope for a transplant to last a patient’s lifetime, but realistically speaking, every type of transplant has a finite lifespan,” said Pomahac, director of Plastic Surgery Transplantation at the Brigham. “Carmen is progressing and recovering very nicely with this second transplant – she is one of the most resilient patients that I have had the opportunity to care for. We call this procedure live-giving, and we are thrilled to offer her the opportunity to return to the type of life that she so richly deserves.”
Tarleton’s first transplant experience was different from other face transplant patients, in that she was highly sensitized by the lifesaving blood products and tissue grafts she needed as a result of her extreme burn injuries. Immunologically complex, it placed her at a higher risk to reject the transplant. These repeated episodes of rejection caused the injury of the deep blood vessels supplying the transplant. This vasculopathy can been seen in other types of transplants and, although it is sometimes called chronic rejection, it is better described as a form of chronic scarring related to previous episodes of rejection.
“Once a patient is highly sensitized, they remain at higher risk of rejection,” said Anil K. Chandraker, MD, director of Renal Transplant Medicine at the Brigham, and a member of the transplant team. “Going into her second face transplant, Carmen was not highly sensitized, not at high risk of rejection, as she had lost nearly all of the HLA antibodies in her blood that had made her previously highly sensitized — likely due to the immunosuppression she had received during the first transplant.”
In addition to the rarity of a second face transplant, Pomahac said the surgery was unique on a couple of other fronts. First, it was marked by an unusually close tissue match from Tarleton’s donor, which lowers her future risk of rejection. Secondly, the surgery progressed differently than the previous ones the Brigham team had performed.
“This will likely serve as a prototype going forward.” said Pomahac. “In addition to the close tissue match, the surgical team paused the transplant approximately 15 hours into the surgery, allowing us to better manage the blood loss, which can interfere with blood clotting during the operation. We completed the surgery the following day, which decreased the time Carmen had to spend in the operating room overall.”
Added Donald J. Annino, Jr., MD, DMD, a surgeon at the Brigham specializing in otolaryngology, “Rescheduling the remainder of the surgery allowed the surgical team to be more efficient and rested. Also, in returning to the OR less than 48 hours after we paused the surgery, swelling and scarring was minimal and the anatomy easily identifiable.”
The Brigham clinical team worked with New England Donor Services (NEDS), the federally designated organ procurement organization responsible for organ and tissue donation in the six New England states, to find the suitable donor match. NEDS facilitates face donation only after a deceased individual has been authorized for organ donation, is deemed a good match by the transplant team and whose next-of-kin has authorized face donation.
“All of us are inspired by the donor family,” said Alexandra Glazier, president and CEO of New England Donor Services. “At a time of grief, they could see beyond their personal loss for the benefit of someone they’ve never met. This is what makes donation and transplant so profoundly moving and meaningful.”
Research into the abilities of face transplant recipients shows that patients can speak, eat and breathe better after transplant. In the most recent study published last year in the New England Journal of Medicine, reporting on the five-year outcomes for six Brigham patients who have received full or partial face transplants, follow-up data showed improved motor and sensory function. In general, face transplant patients report increased functionality to be able to socially reintegrate in a way that would not have been possible before. Overall, patients had a robust return of motor and sensory function of their faces, and all but one patient reported improvements in their quality of life.
The Brigham has long been recognized as one of the world’s leaders in transplantation, having performed the first successful human organ donor transplant, a kidney, in 1954, the first heart transplant in New England in 1984, and the first heart-lung transplant in Massachusetts in 1992. The Brigham performed the nation’s first full face transplant in 2011, and the first bilateral hand transplant in 2014.
Additional information about Carmen Blandin Tarleton is available on our website.