D79. Reports of the Immunologic Management of the World’S First Successful Combined Face and Whole-eye Transplant

PURPOSE: Previous attempts at whole eye transplantation (WET) were ultimately deemed unsuccessful due to both technical and immunologic limitations. Since the first face transplant (FT) in 2005, significant strides have been made in our understanding of both, with multiple groups establishing technical feasibility of FT. Coinciding with this, an improved understanding of immunologic processes and rejection affords the opportunity to revisit WET, especially given its unique immune properties. METHODS: We report on a 46-year-old male who sustained a high voltage electrical injury resulting in severe facial injuries and left eye enucleation. With a cPRA of 32%, following identification of an appropriate donor, the patient underwent a combined partial face and WET with optic nerve coaptation and immune induction using rituximab and anti-thymocyte globulin. RESULTS: Operation time was approximately 21 hours with a total ischemia time of 2 hours and 59 minutes. Initial induction immunosuppression consisted of thymoglobulin at a total dose of 6mg/kg and 1000mg rituximab. Intraoperative administration of isolated donor derived CD34 hematopoietic stem cells directly at the optic nerve coaptation was performed. No postoperative complications were observed during the initial hospital course. Mycophenolate, tacrolimus, and prednisolone were used to maintenance immunosuppression. Now, more than 100 days postoperatively, no evidence of acute rejection, dnDSA, or adverse events has been observed. CONCLUSION: We report the initial immune management of a combined partial face and WET recipient. With a combined T and B lymphocyte depletion protocol, we observed 0 episodes of allograft or transplanted eye rejection more than 100 days postoperatively.