World-first face, eye transplant a 'cautious' success story

An American man who underwent a groundbreaking face and eye transplant after losing his nose, mouth, left eye and face in a 7,200-volt electrical accident has shown no sign of rejection, according to the team that performed the operation.

Aaron James, then 46, also lost most of his left arm when his face touched a live wire while working as an electrical linesman in 2021. Clinicians at NYU Langone Health performed transplant surgery using the face and eye of a single donor in June 2023.

Now, a study led by Dr. Eduardo Rodriguez, director of NYU Langone's Face Transplant Program, has described a "rejection-free” graft, with signs that the retina in James' transplanted eye showed some response to light in MRI scans, though it wasn't perceived by James.

Rodriquez's NYU Langone team also performed the first face and double hand transplant in 2021, and a complex operation to restore the face of a volunteer firefighter in 2015.

Vision restoration was not possible as part of the surgery, but Rodriguez described the outcome as a "foundation for future advancements."

"While the recipient has not regained vision, the transplanted eye has maintained normal pressure, good blood flow and some remaining structure and functions in the retina," said Rodriguez.

"Many experts did not think we would even be here, but we've successfully transplanted and maintained an eye without immune rejection."

Report welcomed, but 'miles to go' to restore vision

"Even if I can't see out of my new eye, I've gained my quality of life back, and I know this is a step forward in the path to help future patients," said James.

In their report on the devastating accident and outcome a year after surgery, published in the Journal of the American Medical Association, the surgical team noted that James' new retina had at least partially survived. They also described the return of facial sensation.

"Although recovery of sensory and motor nerve function often takes months to a year, the patient reported the return of an itchy sensation deep in the left orbit [eye socket] and demonstrated ptosis [drooping] of the left eyelid and slowly improving orbicularis oculi [eyelid closure] and facial memetic muscle function," the report said.

Ophthalmologists have cautiously welcomed the results.

In an independent opinion piece accompanying the report, Elizabeth Bradley and John Woog of the Mayo Clinic's department of ophthalmology remarked "the results of the procedure … offer cautious optimism. The procedure was both a technical and technological tour de force," but there were "miles to go to achieve our goal of restoring function in individuals sustaining life-altering visual loss."

Edited by: Martin Kuebler

Primary source:

Combined Whole Eye and Face Transplant Microsurgical Strategy and 1-Year Clinical Course. Published by Daniel J. Ceradini et al. in JAMA (2024). https://doi:10.1001/jama.2024.12601

Additional sources:

Whole Eye Transplant—The Journey Begins. Published by Elizabeth A. Bradley and John H. Woog in JAMA Ophthalmology (2024) https://doi:10.1001/jamaophthalmol.2024.3670