NEW YORK (AP) – Almost six months after a rare face and hand transplant, Joe DiMeo is relearning to smile, wink, pinch and squeeze.
The 22-year-old New Jersey resident was operated on last August, two years after suffering severe burns in a car accident.
“I knew it would be baby steps to the end,” DiMeo told The Associated Press recently. “It takes a lot of motivation, a lot of patience. And you have to stay strong in everything. “
Experts say it looks like the surgery at NYU Langone Health was a success, but warn it will take a while to be sure.
Worldwide, surgeons have performed at least 18 face transplants and 35 hand transplants, according to the United Network for Organ Sharing, or UNOS, which oversees the United States’ transplant system.
But simultaneous face and two hand transplants are extremely rare and have only been tried twice before. The first attempt was in 2009 on a patient in Paris who died about a month after complications. Two years later, Boston doctors tried again on a woman who was beaten by a chimpanzee, but had to remove the transplanted hands days later.
“The fact that they succeeded is phenomenal,” said Bohdan Pomahac, a surgeon at Brigham and Women’s Hospital in Boston who led the second such attempt. “I know firsthand that it is incredibly complicated. It is a tremendous success. “
DiMeo will be taking medication for life to avoid rejecting transplants, as well as ongoing rehabilitation to gain sensation and function in his new face and hands.
In 2018, DiMeo fell asleep at the wheel, he said, after working the night shift as a product tester for a pharmaceutical company. The car hit a curb and a pole, overturned and burst into flames. Another driver who saw the accident stopped to rescue DiMeo.
After that, he spent months in a medically induced coma and underwent 20 reconstructive surgeries and multiple skin grafts to treat his extensive third-degree burns.
After it became clear that conventional surgeries could not help you regain full vision or use of your hands, DiMeo’s medical team began preparing for a risky transplant in early 2019.
“In the transplant world, they are probably the most unusual,” said Dr. David Klassen, medical director at UNOS.
Almost immediately, the NYU team encountered challenges, including finding a donor.
Doctors estimated that he had only a 6% chance of finding one compatible with his immune system. They also wanted to find someone with the same gender, skin tone and hand control.
Then, during the search for a donor, the pandemic hit and organ donations plummeted. During the rise of New York City, members of the transplant unit were assigned to work in the COVID-19 wards.
In early August, the team finally identified a donor in Delaware and completed the 23-hour procedure a few days later.
They amputated both of DiMeo’s hands, replacing them on the forearm and connecting nerves, blood vessels and 21 tendons with fine hair-like sutures. They also transplanted an entire face, including the forehead, eyebrows, nose, eyelids, lips, ears and underlying facial bones.
“The chance of success on the basis of history seemed small,” said Dr. Eduardo Rodriguez, who led the medical team of more than 140 people. “It’s not that someone has done this many times before and we have a kind of schedule, a recipe to follow.”
So far, DiMeo has shown no signs of rejecting his new face or hands, said Rodriguez.
Since leaving the hospital in November, DiMeo has been undergoing intensive rehabilitation, dedicating daily hours to physical, occupational and speech therapy.
“The rehabilitation was very intense,” said DiMeo, and it involves a lot of “retraining to do things on your own again”.
During a recent session, he practiced raising his eyebrows, opening and closing his eyes, pursing his mouth, raising his thumbs and whistling. DiMeo can feel his new forehead and hands cool, and often reaches out to brush his long hair out of his face.
DiMeo, who lives with her parents, can now dress and feed. He plays pool and plays with his dog Buster. Once an avid gym-goer, DiMeo is also working out again – lifting 25 pounds and practicing his golf swing.
“You have a new chance in life. You really can’t give up, ”he said.
As with any transplant, the risk of rejection is greatest at the beginning, but it lasts indefinitely. The medications you take also leave you vulnerable for the rest of your life to infections.
“You are never free of that risk,” said Klassen. “Transplantation for any patient is a process that takes a long time.”
Still, Rodriguez said he is surprised to see that DiMeo has been able to master skills like zipping up his jacket and putting on his shoes.
“It is very rewarding for all of us,” said Rodriguez. “There is enormous pride.”
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Follow Marion Renault on Twitter: @MarionRenault
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The Associated Press Department of Health and Science receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.