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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_331"
                     title="Physicians Must Treat Transplant Tourists"
                     score="0.008"
                     href="http://www.medpagetoday.com/Gastroenterology/LiverTransplantation/tb/18203?impressionId=1265751623583"
                     
      &lt;p&gt;Patients who travel to foreign countries for organ transplants may return with more problems than they left with  --  and physicians here have a moral responsibility to treat them, researchers asserted in a transplant journal.&lt;/p&gt;
&lt;p&gt;&quot;Medical tourism&quot; has been on the rise as demand for organs outpaces supply and U.S. healthcare costs skyrocket, Thomas D. Schiano, MD, and Rosamond Rhodes, PhD, of Mount Sinai School of Medicine, reported in &lt;em&gt;Liver Transplantation&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Researchers have estimated that 300 medical tourism transplants occurred between 2004 and 2006, with more than 40% of transplant tourists residing in New York or California, which have only 18% of the total U.S. population. (See &lt;a href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/HealthPolicy/12564&quot; mce_href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/HealthPolicy/12564&quot; target=&quot;_blank&quot;&gt;International Medical Trade Turns Big Business&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;Yet physicians have had little guidance on delivering care to these patients, and some transplant centers may turn them away, based on their actions, Schiano and Rhodes wrote.&lt;/p&gt;
&lt;p&gt;Their questions about treatment arose with a 46-year-old Chinese patient who had been put on a waiting list for a liver transplant here because of end-stage liver disease.&lt;/p&gt;
&lt;p&gt;The patient waited on the list for a year as his disease progressed from 18 points to 21 points on a 40-point severity scale.&lt;/p&gt;
&lt;p&gt;Rather than wait any longer, the patient flew to China and had a liver transplant there.&lt;/p&gt;
&lt;p&gt;Many transplanted organs in China come from executed prisoners, raising concerns about disease. Also, foreign transplants may be compromised by poor organ matching, unhealthy donors, and post-transplant infections, while some transplant centers abroad may use substandard surgical techniques, the researchers said.&lt;/p&gt;
&lt;p&gt;Foreign centers are also less likely to send patients home with adequate records and education than centers here, they asserted.&lt;/p&gt;
&lt;p&gt;Three months after his transplant in China, the patient came back to the clinic at Mount Sinai for follow-up care because he was about to run out of imunosuppressive medication.&lt;/p&gt;
&lt;p&gt;Two months after that, the patient developed sepsis due to diffuse intrahepatic biliary stricturing related to hepatic artery thrombosis.&lt;/p&gt;
&lt;p&gt;He required three additional hospitalizations for biliary sepsis, and at that point, retransplantation was the only viable option, Schiano said.&lt;/p&gt;
&lt;p&gt;However, members of the medical team had conflicting views about giving the patient another new liver.&lt;/p&gt;
&lt;p&gt;&quot;He was a medically suitable candidate,&quot; Schiano and Rhodes wrote, &quot;but there was disagreement about whether it was morally right to provide him with a transplant.&quot;&lt;/p&gt;
&lt;p&gt;The clinicians had few ethical guidelines to refer to in making their decision because many deal solely with moral issues related to donors and foreign medical standards.&lt;/p&gt;
&lt;p&gt;For example, the International Society for Heart and Lung Transplantation issued a statement against accepting organs from prisoners in April 2007, and the American Association for the Study of Liver Diseases and the International Liver Transplant Society endorsed similar policies.&lt;/p&gt;
&lt;p&gt;The American Medical Association&apos;s guidelines on medical tourism focus on best practices  --  for example, the procedure must be voluntary, it can&apos;t limit the alternatives offered to patients, and patients should only be referred to accredited institutions.&lt;/p&gt;
&lt;p&gt;While the United Network for Organ Sharing (UNOS)&apos;s statement on medical tourism does maintain that the medical community has an obligation to provide care for these patients, it stops short of offering further direction to transplant programs.&lt;/p&gt;
&lt;p&gt;&quot;Little guidance is provided for dealing with the specific problems of patients who choose to become transplant tourists,&quot; Schiano and Rhodes wrote.&lt;/p&gt;
&lt;p&gt;Instead, they created some ethical guidance for the &quot;moral quandary.&quot;&lt;/p&gt;
&lt;p&gt;Physicians have a &quot;professional obligation to promote the good of patients&quot; as well as a &quot;professional responsibility to adhere to medicine&apos;s commitment to nonjudgmental regard,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;&quot;Taken together, the moral principles of beneficence and nonjudgmental regard direct us to treat potential or returning transplant tourists as we would treat other patients under our care by focusing on providing the medical treatment and support they need,&quot; they continued.&lt;/p&gt;
&lt;p&gt;Physicians shouldn&apos;t deny patients post-transplantation care, and they ought to provide emergent care at the very least. They may refer the patient to another transplant center for long-term follow-up if they regard it as unethical to continue treatment.&lt;/p&gt;
&lt;p&gt;Patients should also be informed about the possibility of transplant tourism when they are not eligible for a transplant in the U.S. or when they are likely to die before reaching the top of the transplant list, Schiano and Rhodes wrote.&lt;/p&gt;
&lt;p&gt;&quot;Patients should not be threatened with abandonment by a center&apos;s refusal to provide care upon their return,&quot; they added.&lt;/p&gt;
&lt;p&gt;As for the 46-year-old patient who was transplanted in China, the Mount Sinai team decided a transplant program must treat all patients on the basis of their need &quot;regardless of what they might have done or how they secured their transplant organ.&quot;&lt;/p&gt;
&lt;p&gt;&quot;Although [the patient] had a long, complicated transplantation course,&quot; they wrote, &quot;he is currently doing well.&quot;&lt;/p&gt;
&lt;p&gt;Mount Sinai has seen a total of nine patients who pursued transplants in China. Three of those had post-transplant problems but had been turned away elsewhere &quot;because several transplant centers in our region do not render care to transplant tourists,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;Seven of those nine patients have hepatitis B. Another three had had a renal transplant in India, and subsequently developed liver failure, the authors reported.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_330"
                     title="Immune Cells Point to Skin Cancer Risk after Transplants (CME/CE)"
                     score="0.008"
                     href="http://www.medpagetoday.com/Nephrology/KidneyTransplantation/tb/18200?impressionId=1265751623583"
                     
      Monitoring two types of immune cells in kidney transplant recipients might identify patients with an increased risk of skin cancer, British investigators reported.&lt;br&gt;
&lt;br&gt;Increased levels of T-regulatory cells (Tregs) more than doubled the risk of squamous cell cancer of the skin. Decreased levels of natural killer (NK) cells were associated with more than a five-fold increased risk of skin cancer.&lt;br&gt;
&lt;br&gt;Both immune parameters had substantially greater predictive power than a history of squamous-cell skin cancer, according to an online report in the &lt;em&gt;Journal of the American Society of Nephrology&lt;/em&gt; by a team of Oxford University investigators.&lt;/p&gt;
&lt;p&gt;&quot;Squamous cell cancer of the skin affects about 30% of kidney transplant patients after 10 years of immunosuppression,&quot; Robert Carroll, MD, currently of Queen Elizabeth Hospital in Woodville, Australia, observed in a statement.&lt;/p&gt;
&lt;p&gt;&quot;A small number of patients develop multiple skin cancers per year, but there is no laboratory test to determine which transplant recipients will develop multiple skin cancers in the future.&quot;&lt;/p&gt;
&lt;p&gt;&quot;If a test can confirm high risk of skin cancer development, this may help clinicians to tailor immunosuppressive regimens for individual patients,&quot; he added.&lt;/p&gt;
&lt;p&gt;Long-term immunosuppression, such as that required for transplant recipients, confers an increased risk of squamous-cell skin cancer.&lt;/p&gt;
&lt;p&gt;Estimates of the magnitude have ranged as high as 200 times greater than the general population, the authors wrote. Additionally, 3% of organ transplant recipients require extensive plastic surgery each year as a result of skin cancer lesions.&lt;/p&gt;
&lt;p&gt;Age at transplantation and the immunosuppression dosage are the principal determinants of skin-cancer risk, and the dosage of immunosuppression also influences the risk of metastasis from squamous-cell cancer of the skin.&lt;/p&gt;
&lt;p&gt;In the general population, cancer has been associated with increased levels of Tregs, including CDR&lt;sup&gt;+&lt;/sup&gt;CD25&lt;sup&gt;high&lt;/sup&gt;FOXP3&lt;sup&gt;+&lt;/sup&gt; and CD8&lt;sup&gt;+&lt;/sup&gt;CD28&lt;sup&gt;-&lt;/sup&gt; cells. The same types of cells could play a role in the risk of skin cancer among organ transplant recipients, the authors wrote.&lt;/p&gt;
&lt;p&gt;Within the tumor microenvironment, Tregs may impair the antitumor activity of CD8&lt;sup&gt;+&lt;/sup&gt; and NK cell. However, in organ transplant recipients, Tregs help control or prevent rejections and may help improve long-term outcomes.&lt;/p&gt;
&lt;p&gt;Different immunosuppressive drugs affect Tregs differently, the authors continued. Sirolimus (Rapamune), for example, increases the number of FOXP3&lt;sup&gt;+&lt;/sup&gt; cells, whereas cyclosporine decreases Treg numbers.&lt;/p&gt;
&lt;p&gt;&quot;Tregs have not been assessed in relation to cancer after transplantation,&quot; the authors wrote. &quot;We therefore investigated the hypothesis that squamous-cell cancer in kidney transplant recipients would be associated with an increased number of Tregs.&quot;&lt;/p&gt;
&lt;p&gt;To examine the hypothesis, investigators phenotyped peripheral blood from 65 kidney transplant recipients with squamous skin cancer and 51 recipients without skin cancer, matched for age, sex, and duration of immunosuppression.&lt;/p&gt;
&lt;p&gt;They also quantified lymphocyte populations in skin cancer lesions from a subset of 25 patients and matched them with 25 other nontransplant patients with squamous cell cancer of the skin.&lt;/p&gt;
&lt;p&gt;The kidney transplant recipients had a median follow-up of 340 days. The investigators found that a concentration of &amp;gt;35 peripheral FOXP3&lt;sup&gt;+&lt;/sup&gt;CD4&lt;sup&gt;+&lt;/sup&gt;CD127&lt;sup&gt;low&lt;/sup&gt; regulatory T cells/&amp;#181;L was associated with a hazard ratio for squamous cell skin cancer of 2.48 (95% CI 1.04 to 5.98).&lt;/p&gt;
&lt;p&gt;An NK cell count &amp;lt;100 cells/&amp;#181;L was associated with a skin cancer hazard ratio of 5.6 (95% CI 1.31 to 24). A history of squamous cell cancer of the skin increased the risk of skin cancer recurrence by a third (HR 1.33, 95% CI 1.15 to 1.53).&lt;/p&gt;
&lt;p&gt;&quot;If similar immune phenotypes are predictive in other kidney transplant recipient populations, then immune phenotype method has the potential to inform immunosuppressive regimen manipulation in kidney transplant recipients at high risk for developing multiple squamous cell cancers,&quot; the authors concluded.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors had no relevant disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_342"
                     title="Stem Cell Transplant Source Does Not Affect Long-Term Leukemia Outcomes (CME/CE)"
                     score="0.007"
                     href="http://www.medpagetoday.com/HematologyOncology/Leukemia/tb/18220?impressionId=1265751623583"
                     
      Ten-year survival rates after allogeneic stem-cell transplant in leukemia patients were the same whether the cells came from donors&apos; bone marrow or peripheral blood, researchers conducting a randomized trial said.&lt;br&gt;
&lt;br&gt;Among 329 patients participating in the trial, overall survival was 49.1% for those receiving peripheral blood progenitor cell transplants versus 56.5% among those receiving bone marrow transplants (&lt;em&gt;P&lt;/em&gt;=0.27), reported Birte Friedrichs, MD, of Charite-Campus Benjamin Franklin in Berlin, Germany, and colleagues online in &lt;em&gt;Lancet Oncology&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;There was also no significant difference over the long term in performance status, ability to work, hematopoietic function, development of bronchiolitis obliterans, or secondary malignancy rates.&lt;/p&gt;
&lt;p&gt;Ten-year leukemia-free survival rates were somewhat better with bone marrow transplant in patients with acute myeloid and acute lymphoblastic leukemia (AML, ALL) but the differences did not reach statistical significance. There was no apparent difference in disease-free survival for those with chronic myeloid leukemia (CML).&lt;/p&gt;
&lt;p&gt;But significantly more transplants involving peripheral blood progenitor cells led to chronic graft-versus-host disease (GVHD), seen in 73% of patients compared with 56% among those receiving bone marrow transplants (&lt;em&gt;P&lt;/em&gt;=0.021).&lt;/p&gt;
&lt;p&gt;As a result, significantly more patients receiving peripheral blood cell transplants were on immunosuppressant therapy five years postprocedure (26% versus 12%, &lt;em&gt;P&lt;/em&gt;=0.024).&lt;/p&gt;
&lt;p&gt;Noting that subgroup analyses did show notable differences in survival in patients with acute leukemias, Friedrichs and colleagues added, &quot;These data alone do not currently support the return to bone marrow transplantation for specific indications, but we believe that long-term data from other randomized trials should be collected.&quot;&lt;/p&gt;
&lt;p&gt;Patients in the study were participating in a parallel-group trial of the two transplant types, with transplants conducted from 1995 to 1999. Participants were adults up to age 55 with CML in second remission or newly diagnosed ALL or AML.&lt;/p&gt;
&lt;p&gt;Specific overall and leukemia-free survival rates for leukemia subtypes after 10 years were: &lt;ul&gt; &lt;li&gt;ALL: 32.9% overall and 28.3% disease-free with bone marrow transplant, 18.2% overall and 13.0% disease free with peripheral blood transplant (&lt;em&gt;P&lt;/em&gt;=0.071 and 0.12, respectively)&lt;/li&gt; &lt;li&gt;AML: 65.3% overall and 62.3% disease-free with bone marrow transplant, 52.3% overall and 47.1% disease-free with peripheral blood transplant (&lt;em&gt;P&lt;/em&gt;=0.24 and 0.16, respectively)&lt;/li&gt; &lt;li&gt;CML: 61.1% overall and 40.2% disease-free with bone marrow transplant, 56.8% overall and 48.5% disease-free with peripheral blood transplant (&lt;em&gt;P&lt;/em&gt;=0.81 and 0.60, respectively)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The failure to find significant differences may have been related to small patient numbers in these subgroups: 64 with AML, 19 with ALL, and 89 with CML.&lt;/p&gt;
&lt;p&gt;Transplant types were performed at equal rates in patients with AML and CML, but the randomization was unbalanced in ALL patients, with 15 of 19 receiving bone marrow transplants.&lt;/p&gt;
&lt;p&gt;Chronic GVHD was the most common cause of death in the study, killing nine patients (of whom six received peripheral blood progenitor cell transplants). Six patients died of recurrent leukemia. The remaining nine deaths were distributed among several causes including hemorrhage, bronchial cancer, suicide, and traffic accident.&lt;/p&gt;
&lt;p&gt;Patients with chronic GVHD after peripheral blood cell transplants were more likely to have skin, liver, and oral mucosal involvement compared with GVHD following bone marrow transplant, with relative risks ranging from 1.49 to 1.85.&lt;/p&gt;
&lt;p&gt;Factors significantly associated with better overall survival included a diagnosis of ALL (HR 2.90 versus other diagnoses, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001), age of 40 or more (HR 1.55 versus age under 40, &lt;em&gt;P&lt;/em&gt;=0.009), and use of total body irradiation instead of a chemotherapy-only myeloablative regimen before transplant (HR 1.55, &lt;em&gt;P&lt;/em&gt;=0.014).&lt;/p&gt;
&lt;p&gt;The researchers noted that many of their findings, including the apparent benefit of preparative total body irradiation, were consistent with earlier studies.&lt;/p&gt;
&lt;p&gt;Limitations to the study included loss to follow-up of 26 patients, lack of detailed data on surviving participants&apos; quality of life, and changes in treatment since the study began.&lt;/p&gt;
&lt;p&gt;Friedrichs and colleagues noted that the introduction of tyrosine kinase inhibitors and new approaches to pretransplant conditioning have altered practice significantly.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;No external funding for the study was received.&lt;/p&gt;&lt;p&gt;No potential conflicts of interest were reported.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_2219"
                     title="FDA Wants Stronger Warnings on Immunosuppressants"
                     score="-0.005"
                     href="http://www.medpagetoday.com/ProductAlert/Prescriptions/tb/15086?impressionId=1265751623583"
                     
       WASHINGTON, July 14 -- The FDA will require beefed up warning labels for a group of immunosuppressant drugs commonly used to prevent organ rejection in kidney transplant patients.
              &lt;p&gt; 
              &lt;p&gt; 
              &lt;p&gt;The FDA said its review of postmarketing data found that use of the drugs can lead to an increase in opportunistic or latent infections, such as the BK virus, which is associated with nephropathy, or even kidney graft loss.
              &lt;p&gt; 
              &lt;p&gt;The required label changes affect the following immunosuppressant drugs:
              &lt;p&gt; 
              &lt;ul&gt;
                &lt;li&gt;sirolimus (Rapamune)
                &lt;li&gt;cyclosporine (Sandimmune) and cyclosporine generics
                &lt;li&gt;cyclosporine modified (Neoral), and generics
                &lt;li&gt;mycophenolate mofetil (Cellcept) and generics
                &lt;li&gt;mycophenolic acid (Myfortic)
              &lt;/ul&gt;
              &lt;p&gt; 
              &lt;p&gt;The label for the immunosuppressant drug tacrolimus (Prograf) already carries the stronger warning language.
    </recommendedItem>
    <recommendedItem id="20090101_19_2224"
                     title="Face Transplant Success Brings Call for Wider Use"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Surgery/PlasticSurgery/tb/15080?impressionId=1265751623583"
                     
      WHEELING, W.Va., July 14 -- The success of last December&apos;s near-total face transplant in Cleveland should prompt consideration of this approach as first-line treatment for severe facial trauma, said the surgeons who performed the operation.
              &lt;br&gt; 
              &lt;br&gt;Reporting on the results online in &lt;em&gt;The Lancet&lt;/em&gt;, Maria Siemionow, MD, of the Cleveland Clinic Foundation, and colleagues said facial transplantation &quot;is a practicable alternative and should be taken into consideration as an early option, if only to spare a patient years of continued disfigurement, social ostracism, and the cumulative financial burden of multiple reconstructions.&quot;
              &lt;br&gt; 
              &lt;br&gt;Seven months after the procedure, the Cleveland patient -- a 45-year-old woman who had taken a close-range shotgun blast in the face in 2004 -- was reported to be healthy and satisfied with the results.
              &lt;br&gt; 
              &lt;br&gt;She was chosen for the transplant after 23 conventional reconstructive procedures had failed to restore basic functions such as the ability to eat, speak, or smell normally, let alone her appearance.
              &lt;p&gt; 
              &lt;p&gt;The woman was receiving most of her nutrition from gastric tubes and had no sense of smell because her nasal cavity was so deformed. The disfigurement also caused her intense humiliation that prevented her from going out in public.
              &lt;p&gt; 
              &lt;p&gt;During the 22-hour transplant procedure, Dr. Siemionow and colleagues removed all the artificial hardware and autologous bone and tissue that had been placed in the previous surgeries.
              &lt;p&gt; 
              &lt;p&gt;They then transferred a composite allograft, from a dead donor, comprising the total nose, lower eyelids, upper lip, total infraorbital floor, bilateral zygomas, and anterior maxilla with incisors, and included total alveolus, anterior hard palate, and bilateral parotid glands.
              &lt;p&gt; 
              &lt;p&gt;Some synthetic materials were used to reconstruct the orbital floors.
              &lt;p&gt; 
              &lt;p&gt;To suppress rejection, the patient received 1 g of methylprednisolone and rabbit antithymocyte globulin on the day of transplant; the methylprednisolone was tapered over six days and the rabbit antithymocyte globulin was continued for an additional eight days.
              &lt;p&gt; 
              &lt;p&gt;Chronic immunosuppression was then maintained with tacrolimus, mycophenolate mofetil, and low-dose oral prednisone. Tacrolimus was titrated to achieve trough levels of 12 to 15 ng/mL for the first three months and then 10 to 12 ng/mL thereafter.
              &lt;p&gt; 
              &lt;p&gt;The patient also received topical methylprednisolone starting on day seven after transplant, initially at 40 mg/day and tapered over several weeks to 10 mg/day.
              &lt;p&gt; 
              &lt;p&gt;Mycophenolate mofetil was given for six months with doses adjusted according to white blood cell counts.
              &lt;p&gt; 
             
&lt;!--- START 2nd EXTRA PHOTO CODE ---&gt;


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&lt;!--- caption text goes below ---&gt;

&lt;b&gt;Patient views before transplantation (A) and after successful reconstruction of the facial defect with restoration of major functional and aesthetic subunits of nose, upper lip, and lower eyelids at six months (B).&lt;/b&gt;
&lt;/td&gt;
&lt;/tr&gt;
&lt;/table&gt;

&lt;!--- END EXTRA PHOTO CODE ---&gt; 


              &lt;p&gt;The patient also received antiviral and antibiotic drugs to prevent emergence of cytomegalovirus and &lt;em&gt;Pneumocystis jerovici&lt;/em&gt; infections. The prophylaxis has been successful, Dr. Siemionow and colleagues reported.
              &lt;p&gt; 
              &lt;p&gt;No clinically overt episodes of acute rejection occurred, but a routine biopsy revealed an episode 47 days post-transplant. It was successfully suppressed with a bolus of 1 g of methylprednisolone. The topical methylprednisolone was also increased to 20 mg/day for about three weeks and was then tapered.
               &lt;p&gt;In an accompanying commentary, Chenggang Yi, MD, and Shuzhong Guo, MD, of Fourth Military Medical University in Xi&apos;an, China, said this approach to rejection management may represent a major step forward in facial transplantation.
              &lt;p&gt; 
              &lt;p&gt;Drs. Li and Guo, who had performed a less extensive partial face transplant in 2006, said reliance on local treatments would allow such procedures to be &quot;widely applied with fewer risks.&quot;
              &lt;p&gt; 
              &lt;p&gt;The Cleveland patient also received psychological counseling daily for six weeks and then three times a week.
              &lt;p&gt; 
              &lt;p&gt;Her assessment of the procedure&apos;s esthetic results has improved over time, her doctors said.
              &lt;p&gt; 
              &lt;p&gt;When she first saw her face three weeks after the transplant, she rated its appearance as 5 out of 10, the same as before the injury. 
              &lt;p&gt;Four months later, her assessment rose to 8 out of 10. She also reported substantially less worry about the change in her looks from before the injury.
              &lt;p&gt; 
              &lt;p&gt;Dr. Siemionow and colleagues emphasized that conventional reconstruction should still be the first approach &quot;when the surgical goal is skin coverage.&quot;
              &lt;p&gt; 
              &lt;p&gt;But for extreme cases involving extensive bone destruction, transplantation should be considered as first-line treatment, they argued.
              &lt;p&gt; 
              &lt;p&gt;They noted that the clinical trial protocol under which the transplant was conducted had been designed in 2004. It took a conservative approach and specified that patients must have already tried and failed to get satisfactory results from conventional surgery.
              &lt;p&gt; 
              &lt;p&gt;They said one of the lessons from their experience &quot;was to rethink our approach of selection only of candidates who had exhausted conventional means of [reconstruction] and to consider presenting face transplantation as an early alternative for patients with massive three-dimensional craniofacial defects and multifunctional deficits.&quot;
              &lt;p&gt; 
              &lt;p&gt;Drs. Li and Guo said some problems with face transplants &quot;remain intractable.&quot;
              &lt;p&gt; 
              &lt;p&gt;Donor availability is still a major challenge because of the need to match many more aspects of the donor tissue than is the case with solid organ transplants.
              &lt;p&gt; 
              &lt;p&gt;Such factors as skin tone, texture, age, and gender, as well as the 3-D size of the area to be transplanted, are critical issues.
              &lt;p&gt; 
              &lt;p&gt;&quot;Because more factors, such as aesthetic result, need to be considered, the selection of recipient and donor for facial transplantation is more difficult than that for solid-organ transplantation,&quot; the Chinese surgeons wrote.
              &lt;p&gt; 
              &lt;p&gt;At this point in the development of facial transplant, they said, &quot;the objective is to identify potential problems and develop management strategies to resolve them.&quot;
              &lt;p&gt; 
              &lt;p&gt;They added, &quot;The day may not be far off when facial transplantation becomes the standard of care for disfigured patients.&quot;
              &lt;p&gt; 
              &lt;p&gt; 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt; The work had no corporate funding.
              &lt;p&gt; 
              &lt;p&gt;No potential conflicts of interest were reported by the transplant team or editorialists.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
    </recommendedItem>
</recommendedContent>