
Face transplant recipient’s donor face now failing - hsnewman
https://www.latimes.com/world-nation/story/2019-09-22/face-transplant-woman-needs-second-operation
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Medicalidiot
This is to be expected. Any time we do any transplant immunosupressants are
given to the recipient for the rest of their life, but this only slows the
inevitable. Heart transplants recipients all get accelerated atherosclerosis.
Lung transplant recipients all get long term fibrosis. We buy time with these
procedures and do everything we can to keep them going, but if you have a
transplant, you're in a really bad spot to begin with.

~~~
peterlk
I just finished up an introductory biology lecture series, and this suddenly
makes less sense to me than it did before. What is it about the foreign cells
that is identified as foreign by the host cells? The cells ought to be
remarkably similar. They're human, with the same function/pluripotency using
the same protein interactions. So why attack it?

~~~
Enginerrrd
Because it's part of the arms race with pathogens that has been going on for a
billion years since multi-cellular life first appeared. Pathogens do lots of
very clever things to hide from the immune system, so the immune system is
tuned to detect very subtle changes. The body largely operates on zero-trust
network models, except for a few locations where the benefit of a too-active
immune system has serious consequences to the fitness of the organism. The
eyes and the testicles are good examples of that in humans.

~~~
wongarsu
To add to this: if the immune system would just check that the cell is human
then every invader would just evolve to pass that check. The only viable way
to defend is to mark the cells as belonging to this specific human. That way
even if some bacteria evolves to trick my immune system it's unlikely to also
trick yours, and the infection can't spread.

~~~
alan-crowe
Additionally, if the immune system would just check that the cell is human,
then humans would be vulnerable to contagious cancer, such as the facial tumor
disease suffered by Tasmanian Devils

[https://en.wikipedia.org/wiki/Devil_facial_tumour_disease](https://en.wikipedia.org/wiki/Devil_facial_tumour_disease)

~~~
mkl
Humans almost certainly are vulnerable to contagious cancer (there are a few
known in other species:
[https://en.wikipedia.org/wiki/Clonally_transmissible_cancer](https://en.wikipedia.org/wiki/Clonally_transmissible_cancer))
. We just haven't acquired/discovered any yet.

~~~
apathy
HTLV, EBV, HPV

you better believe we have! It’s just rare (thank goodness).

~~~
skosch
Those are cancers caused by viruses, and it's the viruses getting transmitted.

On the other hand, clonal transmission refers to the cancer cells _themselves_
leaving sick individual A, entering healthy individual B, and continuing to
reproduce there.

~~~
apathy
You could use transmissible preleukemia (eg CHIP in allo transplants) as an
example if you wished.

Direct unassisted clonal transmission in humans seems likely but, as you
noted, it hasn’t been documented to the extent that Tasmanian Devil facial
tumors have.

Warts are a corner case. I’m not sure whether it’s been determined if some
hosts end up increasing the fitness of the shed cells. If so, that’s quickly
heading towards a globally transmitted precursor lesion.

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DoreenMichele
_Tarleton, who now lives in Manchester, N.H., told the Boston Globe she has no
regrets about the transplant because it dramatically improved her life. She
has learned to play the piano and banjo, wrote a memoir and has spoken to many
groups about her life. She lost 20 pounds and began walking five miles a week.

“I had such a low quality of life prior to my face transplant. Do I wish it
had lasted 10 or 20 years? Of course,” she said._

I was on an email list and a woman who had two lung transplants described some
of what she had been through and also asserted she would do it again and had
no regrets.

You have to understand these are people who have no other viable options.
However bad this is, the alternative is worse.

I wrestle with these questions because I wish we were looking for better
answers. I am in no way interested in telling people who have had transplants
that they were wrong to choose that for themselves.

But transplants are dramatic, heroic, headline grabbing procedures. Helping
people keep their organs functioning so they don't need a transplant has much
less capacity to grab headlines and fascinate the public and so on.

We increasingly put our time and effort into really dramatic medical
procedures that are very expensive and have a _golly, gee whiz_ factor. I
think we are likely largely overlooking better paths that would give a higher
quality of life in many cases because they have less razzle dazzle.

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scotty79
> her estranged husband doused her body with lye after beating her with a
> baseball bat

I'm periodically shocked when I'm reminded of how wide is the spectrum between
good and bad.

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egypturnash
I so do not want to click on this link in case there are pictures. I really do
not want to see what this looks like.

Are there pictures?

~~~
tempguy9999
There's a pic and it's not so pretty. What's much worse to me is the
description of what her husband did to her. Consider skipping this one
altogether.

~~~
plutonorm
I'm a live and let live, everyone has their own pain and their own story, we
all are just doing our best sort of guy... But I want to string that guy up.

~~~
monktastic1
> I'm a live and let live, everyone has their own pain and their own story, we
> all are just doing our best sort of guy... But I want to string that guy up.

I don't think empathy and punishment are at odds with each other. It's
perfectly possible (and, I think, healthy) to have deep compassion for both
victims and perpetrators, while still taking the right corrective measures.

Depending on what exactly "stringing up" entails, I might be right there with
you.

~~~
stickfigure
It's incredibly sad that a horribly abused dog viciously attacks humans; it
didn't didn't deserve that life. You still put it down.

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PeterisP
I mean, in medicine most "fixes" for harsh problems are temporary; nothing is
permanent as in the end we all are going to die sooner or later. There's a
good reason to think not in terms of "people cured" but in metrics like QALY
(quality-adjusted life years) gained - even if this transplant fails tomorrow,
it has given that poor woman 5 years of significantly improved (according to
her own experience) life quality, and that was a good and valuable thing to
achieve even if it turns out that it can't last.

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anon9001
> “We all know we are in uncharted waters,” Tarleton said. “I would rather not
> have to go through a catastrophic failure.”

If anyone hasn't been through some tragic medical shit in their life, pay
attention to that. You'll understand it later.

~~~
rcombine
This is what gets me. Take care of yourself, because you don't know what kind
of Sword of Damocles is hanging over your head.

~~~
pkaye
A lot of us think we are invulnerable when we are young. I had a college
friend who died of brain cancer a few years after graduating. I myself had a
kidney failure a few years ago and now on dialysis. In the snap of a finger
your life can change.

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arbitrage
“There are so many unknowns and so many new things we are discovering,” said
Dr. Bohdan Pomahac, director of plastic surgery transplantation at Brigham and
Women’s and one of Tarleton’s surgeons. Still, he said, “It’s really not
realistic to hope faces are going to last (the patient’s) lifetime.”

~~~
hinkley
What's the mortality rate on transplants? If you keep doing the same surgery
over and over, won't the patient eventually die on the operating table?

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uwuhn
I'm curious to know how much face transplants cost in the US, and if insurance
covers any of it.

~~~
pkaye
I know some of the face transplants were funded by the department of defense.

~~~
tibbydudeza
As potential treatment regime for wounded soldiers who usually are prone to
such horrific injuries.

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isatty
Paywalled.

~~~
arbitrage
I did not see a paywall.

