Human Craniomaxillofacial Allotransplantation
Overview
- Phase
- Phase 2
- Intervention
- Bone marrow cell-based therapy & 1-drug immunosuppression.
- Conditions
- Facial Injuries
- Sponsor
- Johns Hopkins University
- Enrollment
- 15
- Locations
- 1
- Primary Endpoint
- Graft Survival
- Status
- Recruiting
- Last Updated
- 8 months ago
Overview
Brief Summary
Background: The human face is critically important for breathing, eating, seeing, and speaking/ communicating, but its most important job may be to look like a human face. Devastating facial deformities often cause affected individuals to avoid human contact and disappear from society. Although current surgical advancements can somewhat restore facial defects, this process often requires many operations and the resulting face only resembles the human face. To date, over 20 face transplants have been performed with highly encouraging functional and aesthetic results, but widespread clinical use has been limited due to the adverse effects of life-long and high-dose immunosuppression needed to prevent graft rejection. Risks include infection, cancer, and metabolic problems, all of which can greatly affect recipients' quality of life, make the procedure riskier, and jeopardize the potential benefits of face transplantation.
Study Design: This non-randomized, Phase II clinical trial will document the use of a new immunomodulatory protocol (aka - Pittsburgh Protocol, Starzl Protocol) for establishing face transplantation as a safe and effective reconstructive treatment for devastating injuries/ defects by minimizing maintenance immunosuppression therapy in face transplant patients. This protocol combines lymphocyte depletion with donor bone marrow cell infusion and has enabled graft survival using low doses of a single immunosuppressive drug followed by weaning of treatment. Initially designed for living-related solid organ donation, this regimen has been adapted for use with grafts donated by deceased donors. The investigators propose to perform 15 full or partial human face transplants employing this novel protocol.
Specific Aims: 1) To establish face transplantation as a safe and effective reconstructive strategy for the treatment of devastating facial injuries/defects; 2) To reduce the risk of rejection and enable allograft survival while minimizing the requirement for long-term, high-dose, multi-drug immunosuppression.
Significance of Research: Face transplantation could help injured individuals recover functionality, self-esteem, and the ability to reintegrate into family and social life as "whole" individuals. This protocol offers the potential for minimizing the morbidity of maintenance immunosuppression, thereby beneficially shifting the risk/benefit ratio of this life-enhancing procedure and enabling a wider clinical application of face transplantation.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Recent (≥6 months) or remote (i.e., several decades) craniomaxillofacial injury
- •Male or female and of any race, color, or ethnicity.
- •Aged 18-65 years.
- •Strong desire to undergo craniomaxillofacial transplantation.
- •Completes the protocol informed consent form.
- •Non-smoker, defined by having never smoked or having quit \>6 consecutive months prior to screening.
- •No co-existing medical condition which, in the opinion of the study team, could affect the immunomodulatory protocol, surgical procedure, or functional results (see Exclusion Criteria below. If the condition is amenable to treatment, the study team must agree that said condition should not significantly enhance the surgical risks of full or partial craniomaxillofacial transplantation.)
- •No co-existing psycho-social problems (i.e., alcoholism, drug abuse).
- •Negative for malignancy for past 5 years.
- •Negative for HIV at transplant.
Exclusion Criteria
- •Positive for any of the following conditions:
- •Untreated sepsis.
- •HIV (active or seropositive).
- •Active tuberculosis.
- •Active Hepatitis B infection.
- •Hepatitis C.
- •Viral encephalitis.
- •Toxoplasmosis.
- •Malignancy (within past 5 years).
- •Current/recent (within 3 months of donation/screening consent) IV drug abuse.
Arms & Interventions
Treatment (Transplantation)
Face transplantation in combination with a novel donor bone marrow cell-based therapy followed by single-drug immunosuppression with potential weaning.
Intervention: Bone marrow cell-based therapy & 1-drug immunosuppression.
Outcomes
Primary Outcomes
Graft Survival
Time Frame: Transplantation through end of study period (up to 5 years)
Post-operative graft survival will be documented monthly Months 1-12 and quarterly (every 3 months) Years 2-5.
Secondary Outcomes
- Documentation of immunosuppression required by transplanted participants to maintain graft.(Transplantation to end of study period (up to 5 years))