IMPORTANCE: Since 2005, a total of 50 face transplants have been reported from 18 centers in 11 countries. The overall survival of the grafts has not yet been established. OBJECTIVE: To assess the survival of the face transplant grafts and evaluate factors potentially influencing it. DESIGN, SETTING, AND PARTICIPANTS: Data on all the transplants included in this multicenter cohort study were collected at participating transplant centers for updated nonpublished data, supplemented with literature review for nonparticipating centers. Data from 2005 until September 2023, were included. Data were analyzed from November 11, 2005, through September 18, 2023. Patients included the first 50 patients in the world to have received a face transplant. EXPOSURE: Face transplant graft. MAIN OUTCOMES AND MEASURES: The primary outcome was the overall survival of the face transplant graft, defined as either transplant loss or patient death. The secondary outcome was the number of acute rejection episodes per year. RESULTS: The 50 transplants were performed on 39 men (81%) and 9 women (19%) with a median age of 35 (range, 19-68) years at the time of the transplant. The median follow-up time was 8.9 (range, 0.2-16.7) years. During the follow-up, 6 transplants were lost with 2 patients retransplanted. There were 10 patients who died, 2 of whom had lost a transplant. The 5- and 10-year survival of the transplants was 85% (SD, 5%) and 74% (SD, 7%), respectively. The sequential number of the transplant in the world was a significant predictor of survival (hazard ratio, 95; 95% CI, 90-100; P < 05). The median number of acute rejection episodes per year was 1.2 (range, 0-5.3) for the transplants that were lost and 0.7 (range, 0-4.6) for the transplants that survived. No correlation with patient and transplant variables was detected for either the transplant survival or the number of rejection episodes. CONCLUSIONS AND RELEVANCE: In this study, the overall survival of the face transplants is encouraging. These data suggest that the acceptable long-term survival of face transplants makes them a reconstructive option for extensive facial defects.

Department of Oncological and Reconstructive Surgery Maria Sklodowska Curie National Research Institute of Oncology Gliwice Branch Poland

Department of Oral and Maxillofacial Surgery Virgen del Rocio University Hospital University of Seville Seville Spain

Department of Plastic and Reconstructive Surgery Akdeniz University School of Medicine Antalya Turkey

Department of Plastic and Reconstructive Surgery Ghent University Hospital Ghent Belgium

Department of Plastic Reconstructive and Aesthetic Surgery Hôpital Européen Georges Pompidou Assistance Publique Hôpitaux de Paris Université de Paris Paris Descartes Paris France

Department of Plastic Reconstructive and Aesthetic Surgery School of Medicine Hacettepe University Hacettepe Üniversitesi Ankara Turkey

Department of Plastic Surgery and Burns Vall d'Hebron Barcelona Hospital Campus Universitat Autònoma de Barcelona Barcelona Spain

Department of Plastic Surgery Cleveland Clinic Cleveland Ohio

Department of Plastic Surgery Helsinki University Hospital University of Helsinki Puistosairaala HUS Finland

Department of Plastic Surgery Koc University School of Medicine Topkapı Koç Üniversitesi Hastanesi Zeytinburnu Istanbul Turkey

Department of Surgery NYU Grossman School of Medicine New York New York

Department of Transplantation Edouard Herriot Hospital Hospices Civils de Lyon Lyon France

Department of Transplantation Nephrology and Clinical Immunology Edouard Herriot Hospital Hospices Civils de Lyon Lyon France

Division of Plastic and Reconstructive Surgery Department of Surgery Mayo Clinic Rochester Minnesota

Division of Plastic Surgery Department of Surgery Yale New Haven Hospital Yale School of Medicine New Haven Connecticut

Division of Plastic Surgery University of Montreal Montreal Quebec Canada

Hansjörg Wyss Department of Plastic Surgery New York University New York New York

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