The world's first whole-eye and partial-face transplant recipient continues recovery with viable eye 1 year after landmark surgery

(Image credit: AdobeStock/Syda Productions)

A surgical team at NYU Langone Health in May 2023 performed the world’s first whole-eye and partial-face transplants for military veteran Aaron James, 46, who had survived a high-voltage electrical accident at work.

More than a year later, James continues to make progress in his recovery and is back to daily life at his home in Arkansas.

In a study published in this month in the Journal of the American Medical Association (JAMA),¹ researchers detailed clinical outcomes and discoveries from the past year.

According to the study, the transplanted donor eye has maintained normal pressure and blood flow since the transplant. This differed from results with previous animal models of whole-eye transplants, where the eye often shrank significantly.

While the transplanted eye has not regained vision, electroretinography—a test that measures the retina's electrical response to light—demonstrated a photoreceptor response, indicating that rods and cones, the light-sensitive nerve cells in the eye, survived the transplant.¹

The researchers noted that this electrical response converts light into signals that ultimately the brain could interpret for vision, giving hope for the future of whole-eye transplants with an aim to restore sight.¹

"Our discoveries over the past year mark promising initial results, laying a foundation for further advancements and ongoing research," Eduardo D. Rodriguez, MD, DDS, senior author on the study, and the surgeon who led a team of more than 140 medical professionals who collaborated on the procedure, said in a NYU Langone Health news release.²

Rodriguez added that the medical team continues to be truly amazed by James’ recovery, with no episodes of rejection.

“Our methodical approach to the matching process, ensuring that Aaron received the most favorable donor match, along with our unique immunosuppression regimen, has set the standard for eliminating and avoiding early rejection episodes,” said Rodriguez, who is director of the Face Transplant Program, the Helen L. Kimmel Professor of Reconstructive Plastic Surgery, chair of the Hansjörg-Wyss Department of Plastic Surgery at NYU Langone.

Allison Rojas, NP; Aaron James; Eduardo Rodriguez,MD, DDS; and Daniel Ceradini, MD. (Image credit: NYU Langone Health)

The JAMA study, led by Rodriguez and his colleagues in the Hansjörg Wyss Department of Plastic Surgery, the Departments of Ophthalmology and Radiology as well as NYU Langone’s Transplant Institute.^1,2

In the study, the researchers detail the 21-hour surgery, during which surgeons used microsurgical techniques, customized surgical devices, and cell-based therapies. The procedure included the first attempt in injecting stem cells into a human optic nerve during transplant, aiming to enhance nerve regeneration.1

Moreover, the researchers also detail the challenges presented by a combined whole-eye and partial-face transplant but demonstrate that the procedure can restore important functions and structures for the patient.

In the study, the researchers also detailed results from several clinical tests conducted on the transplanted donor eye over the past year, using various evaluation methods.

During these examinations, researchers detected some hopeful results, like normal eye pressure, good blood flow in the eye, and some remaining structure in the retina.

However, the researchers noted that there has been no ability to see light and some detectable damage to the optic nerve has resulted in some loss of retinal tissue as the eye recovered.

The researchers conclude that additional tests are needed to draw more definitive conclusions from these initial measurements.

"Our study is the first to show the feasibility of whole-eye transplant in conjunction with a face transplant," Vaidehi S. Dedania, MD, James’ ophthalmologist and retina specialist in the Department of Ophthalmology at NYU Langone, said in the news release. “The outcomes we're seeing after this procedure are quite incredible and could pave the way for new clinical protocols and inspire further research into complex transplants involving critical sensory organs."

A year of milestones

For James, the past year has included a number of milestones that many people may take for granted, from no more stares from strangers, the ability to enjoy solid foods again, and even the simple pleasures of smelling. He can now direct his attention to family, including sending his daughter, Allie, off to college.²

"I'm pretty much back to being a normal guy, doing normal things," James said in a statement. "All in all, though, this has been the most transformative year of my life. I've been given the gift of a second chance, and I don't take a single moment for granted."

A key milestone that James looked forward to was a recent visit to the DMV to finally replace his old driver's license. He was able to trade in the old license, which was a reminder of his past with an image of his injured face, for one that reflects his new identity brought tears to the eyes of DMV workers.

Daniel J. Ceradini, MD, first author of the study, who is director of research and associate professor in the Hansjörg Wyss Department of Plastic Surgery, highlighted just what the procedure means for James.

"The aesthetic outcomes and quality of life this procedure has provided to Aaron should not be overshadowed," he said in the news release. “He has regained many elements of life he lost after the 2021 injury, and that's our ultimate goal."

For his part, James continues regular follow-up appointments at NYU Langone and said he feels proud to be a part of such transformative research.

"I have felt honored to be patient zero,” he said in the release. “Even if I can't see out of my new eye, I've gained my quality of life back, and I know this is a step forward in the path to help future patients.”

Looking ahead

More than 7 million Americans are impacted by vision loss. There are therapies that can slow its progression, but none currently restore sight. Whole-eye transplants to restore vision have remained elusive because of the complexity of the eye. The range of challenges include maintaining retinal blood flow, preventing immune rejection, preserving how the eye responds to light, and ensuring the nerves and connections to the brain regrow and make functional connections to the brain.^1,2

Paul W., Glimcher, PhD, director of NYU Langone’s Neuroscience Institute and chair of the Department of Neuroscience and Physiology, said the first challenge is successfully transplanting an entire eye into a new human and keeping that eye alive without rejection—a feat Rodriguez and the NYU Langone team have achieved.

“The next hurdle is preserving the nerve cells in the eye during the transplant process, and in this case, it's remarkable that some parts of the retina have survived over the past year,” he said in the NYU Langone news release. “The critical task ahead is to ensure that all of the eye cells survive the transplant, which is essential for restoring connections to the brain. That is the fundamental requirement for vision, as sight is primarily a function of the brain, not just the eyes."

The human eye is connected to the brain through the optic nerve, part of the central nervous system and responsible for transmitting visual information to the brain. The researchers will continue the journey with James through uncharted territory in medical science.²

"We've done the work to transplant an eye. We now need to do more work in understanding how to restore sight to the eye," Rodriguez concluded. "We look forward to continuing this research in collaboration across academia to accelerate these discoveries with unique tools and the best therapies."

The work was supported by NYU Langone Health and NYU Grossman School of Medicine. Magnetic resonance imaging tractography studies were supported by National Institutes of Health grant RO1 EB028774.

Reference:

1. Ceradini DJ, Tran DL, Dedania VS, et al. Combined Whole Eye and Face Transplant: Microsurgical Strategy and 1-Year Clinical Course. JAMA. Published online September 09, 2024. doi:10.1001/jama.2024.12601

2. NYU Langone Health. The World’s First Whole-Eye & Partial-Face Transplant Recipient Achieves Remarkable Recovery, with Viable Eye One Year After Landmark Surgery. Prnewswire.com. Published September 10, 2024. Accessed September 10, 2024. https://www.prnewswire.com/news-releases/the-worlds-first-whole-eye--partial-face-transplant-recipient-achieves-remarkable-recovery-with-viable-eye-one-year-after-landmark-surgery-302242949.html