Earlier this year, in an operating room in New York City, a man’s life was changed.
When a horrific work accident occurred two years ago, power lineman Aaron James received a fatal 7,200-volt shock when his face accidentally touched a live wire.
James, 46, suffered major injuries, including the loss of his left eye, his dominant left arm from above the elbow, his entire nose and lips, his front teeth, his left cheek area and chin down to the bone.
The outlook for James, an Army veteran living in Arkansas, is decidedly bleak.
But surgeons at NYU Langone Health made medical history in May with an unprecedented operation – the first whole eye transplant in humans, and the only successful whole eye and partial face transplant ever performed.
The complex surgical procedure involved more than 140 surgeons, nurses and other healthcare professionals led by Dr. Eduardo D. Rodriguez, director of the Face Transplant Program and chair of the Department of Plastic Surgery at NYU Langone.
“We could not have asked for a more perfect patient,” Rodriguez said in a statement. “Aaron is very motivated to regain the function and independence he lost after his injury.”
Aaron James, pictured here with his wife Meagan, served in the Army National Guard for 10 years.
Weighing the risk vs. reward
James received initial treatment at a Texas medical center, and the NYU Langone team was introduced to his case two months after his accident. Last year, James was evaluated for a face transplant.
But because of the severe pain, Texas surgeons had to remove his injured left eye. Rodriguez recommends that surgeons leave as much of the optic nerve as possible, in hopes that the transplant might restore some level of vision.
That opened up discussions about possible eye-to-face transplants — something that hadn’t been attempted anywhere.
The unprecedented operation was fraught with risk, and despite some cosmetic improvements for James, the outcome was uncertain.
But the James family and the surgical team at NYU Langone decided to press on.
“Since James needs a face transplant and will be taking immunosuppressive drugs regardless, the risk to reward ratio of an eye transplant is very low. Even if the eye is successfully transplanted, from a cosmetic point of view, it will still be a remarkable achievement,” said Rodriguez.
James was working as a high voltage lineman in Arkansas at the time of his injury.
‘Donor heroes’ found
A stroke of luck happened when LiveOnNY, an organ procurement organization for the greater New York metropolitan area, quickly identified a potential donor at another hospital in New York City.
“The hero donor is a young man in his 30s who comes from a family that strongly supports giving,” said Leonard Achan, president and CEO of LiveOnNY.
“He generously donated the tissue that led to this successful face and eye transplant, but also saved three other individuals between the ages of 20 and 70, donating their kidneys, liver and pancreas,” added Achan.
Aaron James, pictured here with his daughter Allie, after his injury and before surgery. COURTESY OF THE JAMES FAMILY
Eye transplant challenges
Transplanting a human eye is a very complex process because of the challenges associated with the regeneration of the optic nerve, blood flow to the retina and the possibility that the immune system will reject any new body organ or tissue.
Rodriguez and the team at the NYU Langone Center for Transplantation and Cellular Therapy decided to combine the donor’s eyes with stem cells derived from the donor.
Transplanted stem cells can function as nature’s “repair crew,” dividing again and again to create healthy cells that replace damaged or dysfunctional tissue.
“This is the first attempt to inject adult stem cells into the human optic nerve during transplantation with the hope of improving nerve regeneration,” said Dr. Samer Al-Homsi, executive director of the Center for Transplantation and Cellular Therapy at NYU Langone.
Complex surgical procedures involve a team of more than 140 surgeons, nurses and other health care professionals. NYU Langone Health
A carefully trained operation
The 21-hour surgery took place at NYU Langone’s Kimmel Pavilion, where two different surgical teams simultaneously operated in both the donor and recipient rooms.
Each team adheres to a carefully planned timetable — which has been rehearsed several times over the past year — to integrate the donor’s face and eyes to James as quickly as possible.
Face transplants include the nose, left eyelid and eyebrows, lips and the base of the skull, cheeks, nose and chin, as well as muscles, blood vessels and nerves.
Simultaneous eye transplantation includes the entire left eye and socket, as well as the orbital bone and all surrounding tissue, including the optic nerve.
The transplanted left eye currently has no vision, but over the past six months, it has shown signs of remarkable health, including smooth blood flow to the retina. If the organ stays healthy, there’s a chance it could restore vision — but all they can do is hope.
Dr. Eduardo Rodriguez examines Aaron James after his surgery.AP
Results ‘far exceeded our initial expectations’
The successful outcome of a complex surgical procedure has exceeded the high expectations of the healthcare team.
“The progress we’ve seen with the eye is remarkable, especially given that we have a viable cornea paired with a retina that shows great blood flow five months after the procedure,” said Dr. Bruce Gelb, a transplant surgeon at the NYU Langone Transplant Institute.
“This far exceeded our initial expectations, as our best hope was that the points would last at least 90 days,” added Gelb.
Rodriguez agreed: “Beyond the eyes, the quality of Aaron’s results from the face transplant was special. You wouldn’t think he underwent such a procedure recently. He looks great.”
One twist: The donor’s eyes are brown, and James’ eyes are blue, giving him heterochromia (different colored eyes in the same person).
Aaron James before his injury (left), and after successful surgery.
‘Second chance at life’
After surgery, James spent just 17 days in the Intensive Care Unit at NYU Langone — one of the shortest recoveries among Rodriguez face transplant recipients.
James is now back home in Arkansas, where he is looking forward to spending Thanksgiving with his family and eating a holiday meal for the first time since his injury in 2021.
“I am very grateful to the donor and his family, who have given me a second chance at life in their own difficult time,” said James.
“I will also be forever grateful to Dr. Rodriguez and his team for changing my life. My family and I would not have been able to get through this difficult journey without their expertise and support.”
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Source: thtrangdai.edu.vn/en/
