Mortality and graft loss in face transplantation: lessons from two decades of experience

Despite major advances in medicine, defects of the face and extremities caused by burns, trauma, congenital anomalies, or malignancy-related surgery remain a formidable challenge for surgeons. These conditions severely limit patients' quality of life by impairing function, creating disfigurement, and causing psychological distress, social difficulties, and diminished self-esteem. In particular, the loss of motor and sensory function complicates treatment and recovery. Vascularized composite allotransplantation has emerged as a promising option, offering restoration of form and function, although its benefits are accompanied by considerable risks. This review analyzes mortality in all face transplants reported worldwide since the first procedure in 2005, encompassing 51 procedures (including revisions) identified in PubMed/Medline up to September 2025. The findings show that complications related to immunosuppression, such as infection, malignancy, and acute and chronic rejection, as well as patient-related and psychological issues remain major contributors to adverse outcomes, including mortality. Mortality in face transplantation highlights the need for refined immunosuppressive regimens, improved patient selection, and comprehensive multidisciplinary support to optimize long-term survival and quality of life.