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World-first whole-eye and partial-face transplant deemed a success
A huge multidisciplinary team at NYU Langone Health has successfully undertaken the world’s first whole-eye and partial-face transplant on a man who suffered horrific injuries after a high-voltage electrical accident. The landmark surgery opens new possibilities for future advancements in vision therapies.
In June 2021, 46-year-old Aaron James’ face accidentally touched a live wire while he was working as an electrical lineman. Although he survived the 7,200-volt electric shock, a feat in itself, Aaron, who hails from Hot Springs, Arkansas, was left with devastating injuries that included the loss of his left eye, nose and lips, front teeth, left cheek and chin, and his left arm from above the elbow.
The journey to a groundbreaking operation
Aaron was introduced to the multidisciplinary NYU Langone Health team a couple of months after his accident and began early-phase reconstructions at a Texas medical center where he was receiving care. Over the following year, the possibility of a face transplant was discussed with NYU Langone’s Drs Eduardo Rodriguez, director of the Face Transplant Program, and Helen Kimmel, professor of reconstructive plastic surgery.
When Texas surgeons had to remove Aaron’s left eye due to severe pain, Rodriguez recommended cutting the optic nerve as close to the eyeball as possible as preserving nerve length would maximize reconstructive options, including the potential for an eye transplant down the track. This triggered ongoing discussions about combining a face transplant with a whole-eye transplant, something that had never been attempted before.
“Given Aaron needed a face transplant and will be taking immunosuppressive drugs regardless, the risk versus reward ratio of transplanting the eye was very low,” said Rodriguez. “Despite the eye being successfully transplanted, from a cosmetic standpoint, it would still be a remarkable achievement.”
Quick turnaround: On the donor waitlist
In February 2023, Aaron was officially shortlisted as a transplant recipient with the United Network for Organ Sharing (UNOS), the private, non-profit organization that manages the US’ organ transplant system. LiveOnNY, the organ procurement organization for the greater New York metropolitan area, was also involved in finding a donor. Three months after Aaron was listed for organ donation, LiveOnNY identified a potential donor who, after testing, was deemed suitable. The journey from injury to transplant took a little under two years.
Rodriguez led the transplant surgery, which took place on May 27, lasted around 21 hours and included a team of more than 140 surgeons, nurses, and other healthcare professionals. Two surgical teams simultaneously operated in two ORs, one that housed the donor and one for Aaron.
Overcoming the challenges of eye transplantation
While corneal transplants have become relatively common, successful whole-eye transplants are rare due to the intricacies of the optic nerve and the challenges of nerve regeneration, immune rejection and restoring blood flow to the retina. To overcome these challenges, the NYU Langone team combined the donor eye with bone marrow-derived adult stem cells harvested from the donor’s vertebrae.
“This is the first attempt of injecting adult stem cells into a human optic nerve during a transplant in the hopes of enhancing nerve regeneration,” said Samer Al-Homsi, executive director of the Transplantation and Cellular Therapy Center and professor in NYU Langone’s Department of Medicine. “We chose to use CD34-positive stem cells which have been shown to harbor the potential to replace damaged cells and [have] neuroprotective properties.”
Incorporating stem cells into the eye transplant procedure provides a learning opportunity.
“We have now demonstrated that the procedure is safe and potentially efficacious, but we need time to determine if this step plays a role in enhancing the chance of sight restoration and if there’s anything further that can be done in the future to optimize the procedure,” Al-Homsi said.
State-of-the-art tech transforms face transplantation
State-of-the-art technology was crucial to the face transplantation process, both before and during surgery. 3D computer surgical planning and patient-specific 3D cutting guides enabled precise alignment of bones and optimal placement of implantable screws and plates, ensuring that the face and eye were seamlessly integrated into Aaron’s face.
In addition to transplanting the whole left eye and socket, including the orbital bones, surrounding eye tissues, and the optic nerve, Rodriguez and his seven-strong surgical team – assisted by an OR team of 80 – transplanted a long list of facial features. It included the partial face, including the nose, left upper and lower eyelids, left eyebrow, upper and lower lips, and underlying skull, cheek, nose and chin bone segments, with all of the tissues below the right eye, including the underlying muscles, blood vessels, and nerves.
Post-transplant progress and seeing into the future
Aaron spent only 17 days in the intensive care unit at NYU Langone, one of the shortest recoveries among Rodriguez’s face transplant recipients. He was discharged to a nearby apartment on July 6 and continued outpatient rehabilitation that included physical, occupational and speech therapy. Rodriguez performed minor follow-up surgery to optimize Aaron’s functional and aesthetic outcome.
“Beyond the eye, the quality of Aaron’s results from the face transplant is special,” Rodriguez said. “You would never think he underwent such a procedure so recently. He looks great.”
The success of the eye transplant has exceeded expectations.
“The progress we’ve seen with the eye is exceptional, especially considering that we have a viable cornea paired with a retina showing great blood flow five months after the procedure,” said Bruce Gelb, a transplant surgeon at the NYU Langone Transplant Institute. “This far exceeds our initial expectations, given our initial hope was that the eye would survive at least 90 days. We will continue to monitor, and I am excited to see what else we may learn over time.”
Aaron can’t currently see out of the transplanted left eye. However, over the last six months, the eye has shown remarkable signs of health. Rodriguez and a posse of research scientists and clinicians continue to meet and discuss restoring Aaron’s sight.
“This is certainly one extraordinary step in the right direction,” said Steven Galetta, neuro-ophthalmologist and Professor and Chair of Neurology at NYU Langone. “We’re now crossing into the frontier of the central nervous system. Whatever happens next allows the opportunity for various methods to try to enhance the remaining aspects of the retina, whether it be through growth factors, stem cells, or a device that can pick up the signals and then bypass things along that optic nerve pathway. I’m looking forward to further advancements from this case in collaboration with the very talented minds that made it happen here at NYU Langone.”
Grateful and motivated
Rodriguez continues to be impressed by Aaron’s determination.
“Aaron has been extremely motivated to regain the function and independence he lost after his injury,” he said. “We couldn’t have asked for a more perfect patient.”
Returning to Arkansas on September 14 with his wife, Meagan, and daughter, Allie, Aaron travels to New York monthly for follow-up appointments.
“I’m grateful beyond words for the donor and his family, who have given me a second chance at life during their own time of great difficulty,” Aaron said. “I hope the family finds solace in knowing that part of the donor lives on with me. I will also forever be thankful to Dr Rodriguez and his team for changing my life. My family and I wouldn’t have been able to navigate this difficult journey without their expertise and support. Our hope is that my story can serve as inspiration for those facing severe facial and ocular injuries.”
注释：
multidisciplinary: adj
表示"包括各种学科的；有关各种学问的"，如：The Center proides a multidisciplinary approach to care. 中心还能提供多学科间综合性的治疗。
hail: v
表示"来自;招呼致意，向...欢呼，为…喝彩"，means " greet; give a welcome cry to"，如：They hail from all parts of the country. 他们来自全国各地。An old friend hailed me from the other side of the street. 一个老朋友从街的对面喊我。
optic: adj
表示" 视觉的；光学的"，means "of or relating to or resembling the eye"，如：His optic nerve was hurt in an accident. 他的视神经在一次事故中受到损伤。
immunosuppressive: adj
表示" 抑制免疫反应的"，means "of or relating to a substance that lowers the body's normal immune response and induces immunosuppression"，如：The use of new immunosuppressive drugs has further improved clinical results. 使用了新型的免疫抑制药物是取得好的临床效果的保证。
intricacy: n
表示" 纷乱；错综复杂"，means "marked by elaborately complex detail"，如：The intricacy of software systems has increased significantly. 软件系统的错综复杂程度大大增加了。
retina: n
表示"视网膜"，如：Sight is made possible by rays of light impinging on the retina.由于光线射到视网膜上,眼睛才看得见。
vertebrae: n
表示" [解]椎骨"，如：A mouse has the same number of neck vertebrae as a giraffe does. 老鼠和长颈鹿的颈椎骨数目相同。
neuroprotective: n
表示" 保护神经"，如：Many researches show that propofol has neuroprotective effect. 研究显示,丙泊酚具有一定的脑保护作用。
efficacious: adj
表示" 有效的；灵验的"，如：Vaccination for smallpox is efficacious. 种牛痘防天花是有效的。
rehabilitation: n
表示" 修复；复原"，means "the restoration of someone to a useful place in society"，如：Drug rehabilitation is a long and painful process. 戒毒是一个漫长而痛苦的过程。
viable: adj
表示"能生存的；可行的"，means "capable of being done with means at hand and circumstances as they are"，如：The economy of the country is not viable. 这个国家经济是难以维持的。
cornea: n
表示"角膜"，如：Light enters the eye through the cornea. 光通过角膜进入眼睛。
solace: n
表示" 安慰；慰藉"，means "the act of consoling; giving relief in affliction"，如：The sick man found solace in music. 那男病人从音乐中获得了安慰。
ocular: adj
表示" 眼睛的；视觉的；目击的"，means "of or relating to or resembling the eye"，如：The ocular defects made him lose the chance for the job. 视力缺陷让他失去了这个工作的机会。
中文简要说明：
纽约大学朗格健康中心(NYU Langone Health)的医疗团队，刚刚完成了「眼球与脸部同时移植」的复杂手术，成功地挽救一名被高压电所严重伤害的电气工。他原本破碎的脸已经正常许多，而且新获得的左眼，也似乎已在重建视力。这绝对是是医疗技术的重要里程碑。
新阿特拉斯(New Altas)报导，2021年6月，46岁的亚伦詹姆斯(Aaron James)在修复电力系统时，脸部不小心碰到了带电电线，而且这条电线带有7,200伏特的高压电，整个脸部遭受了毁灭性的伤害，失去了左眼、鼻子和嘴唇、门牙、左脸颊和下巴，他的左臂也被烧毁。
亚伦在几场重大手术后，终于悻存下来，随后他被送往纽约大学朗格健康中心的科学团队，开始他的早期重建。在接下来的一年里，医疗团队当中的脸部移植计划主任罗德里格斯博士(Eduardo Rodriguez)，和整形外科教授金梅尔(Helen Kimmel)，讨论了脸部移植的可能性。
在最初的手术时，亚伦的左眼因伤势太重而不得不切除，当时罗德里格斯博士就建议主刀医生，下刀处尽可能靠近眼球，以保留长一点的视神经，以便在未来，执行眼部移植的可能性，这是以前从未尝试过的。
罗德里格斯说：「鉴于亚伦需要进行面部移植手术，并且无论如何都会服用免疫抑制药物，所以我知道，眼睛移植的风险很高，而且成功回报率非常低。但是即使从美容的角度来看，这仍然是一个了不起的成就。」
2023 年 2 月，亚伦被排入器官共享联合网 (UNOS)当中，这是管理美国器官移植系统的非营利组织。3个月后，找到了一位潜在的捐赠者，此时离他受伤，不超过两年的时间。
罗德里格斯领导的移植手术于 5 月 27 日进行，这个个浩大的手术，时间持续了21小时，团队成员包括140多名外科医生、护士和其他医疗专业人员。两个手术小组同时在两间手术室进行，一间是捐赠者，另一间是亚伦。
其中最困难的手术，当然是眼球移植，虽然器官移植手术已超过60年，但是眼睛又小又复杂，其中涉及神经再生、免疫排斥和恢复视网膜血流的挑战。为了克服这些挑战，医疗团队将捐赠者的眼睛，与从捐赠者的椎骨中，收集一些骨髓，收获得足够数量的成体干细胞，企图由这些干细胞来修复眼球的细部组织。这是首次注射成体干细胞，以增强神经再生的尝试。
纽约大学的眼科教授荷西(Samer Al-Homsi)说：「我们选择使用 CD34 阳性干细胞，这些细胞已被证明具有替代受损细胞的潜力，并对神经组织有保护特性。」
「我们确定此项手术是安全的，并且可能有效，但是能否恢复视力，则是需要进一步的尝试。」
再说脸部重建手术，团队先利用3D计算机建模，以确定要如何设计人工增补骨，以及如何保持捐赠者的脸部外型，在计算机的规划下，实现了骨骼的精确对准以及植入螺丝和增补骨板的最佳放置。
包括左眼和眼窝、眼眶骨、外围眼组织和视神经外， 80 名手术室团队重新安装了鼻子、左上眼睑、下眼睑、左眉毛、上下嘴唇，当然还要连接肌肉、血管和神经。
惊人的是，亚伦在完成手术后，只在加护病房里待了 17 天，之后就可转到普通病房，这是面部移植接受者中，康复时间最短的人之一，也显示新一代医疗技术的成功。亚伦于7 月 6 日出院，之后继续接受门诊复健治疗，包括身体、职业和语言治疗。
罗德里格斯说：「亚伦面部手术的效果好的令人难以置信，几乎看不出来曾经毁容过，他看起来好极了。」
另一个好消息是，眼部移植手术的成功程度也超出了预期。医疗团队的眼部主任盖尔布(Bruce Gelb) 表示：「我们在眼睛的部分，进展非常良好。其中角膜和视网膜在手术的后五个月，已经有充足的血流，这证明这些组织是活的。」
「这真的远远超出了我们的预期，我们最初认为，这只眼睛能存活 90 天就已经达到标准。我们将继续观察后续情况。」
不过，亚伦目前还无法用移植的左眼看到东西。然而，在过去的六个月里，从医学的角度来看，眼睛已显示出持续健康的迹象。
眼科神经医生、神经病学教授兼主任加莱塔 (Steven Galetta) 说：「我们已达到新的医学领域，现在正在试着跨越中枢神经系统的障碍。无论接下来发生什么事，都让我们更了解视网膜与视神经如何连接的知识。」
9 月 14 日，亚伦与妻女返回阿肯色州，他每个月再前往纽约复诊。他说：「我对捐赠者及其家人的感激之情难以言表，他们给了我第二次生命的机会。我也将永远感谢罗德里格斯博士和他的团队，改变了我的生活。如果没有他们的专业知识和支持，我和我的家人很难度过接下来的路。我希望我的经验，能够为医学做出贡献。」
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