顔面と両手の同時移植手術に成功、世界初　交通事故で大やけどの米男性

【ワシントンＡＦＰ＝時事】米ニューヨーク大学ランゴーン医療センターは3日、交通事故で重いやけどを負った米ニュージャージー州の男性に顔面と両手の同時移植手術を行い、世界で初めて成功したと発表した。（写真は顔面と両手の移植手術を受けたジョー・ディメオさん。米ニューヨーク大学ランゴーン医療センター提供）
　ジョー・ディメオさん（２２）は２０１８年７月、夜勤明けの帰宅中に居眠り運転で交通事故を起こしてしまった。車は横転、爆発。ディメオさんは通り掛かった人に救助されたが、全身の８割以上に最も重症の「３度」のやけどを負った。指先は切断を余儀なくされ、顔にも大きな傷を受けて唇とまぶたを失い、視力にも影響が出るなど、自立した日常生活を送るのが難しい状態となった。
　４か月もの間やけど治療専門の病棟に入院したディメオさんは、２か月半近く人工的な昏睡（こんすい）状態に置かれ、何度も移植手術や輸血を受けた。
　だが、３日にランゴーン医療センターが主催した記者会見で、ディメオさんは「二度目の人生を歩むチャンス」をもらったと語り、希望のメッセージを伝えた。「トンネルの先には、常に光がある。絶対に諦めないでほしい」
　ディメオさんの移植手術は３Ｄプリンターを活用した画期的なもので、２０２０年８月１２日、総勢９６人の医療チームによって行われた。チームを率いたランゴーン医療センター顔面移植プログラム責任者の外科医、エドゥアルド・ロドリゲス医師は、すでに３回の顔面移植手術を担当した経験があったが、手の移植手術を指示するのは初めてだった。
　手術は約２３時間に及んだ。ロドリゲス医師はディメオさんについて、「これまで出会った中で最も意欲的な患者」と評した。
　顔面と手の同時移植手術は２回の前例があるが、いずれも失敗している。一例は感染症による合併症で患者が死亡し、もう一例は移植した両手が生着せず、除去せざるを得なかった。
　全米を対象としたディメオさんのドナー探しは、「干し草の山の中から１本の針を見つける」ような作業だったとロドリゲス医師は言う。最終的にデラウェア州で条件にぴったり合致したドナーが見つかった。
　移植されたのは左右の前腕部の半ばから手先までと、顔面全体だ。両手の移植には前腕の２本の骨と手につながる支配神経３本、血管６本、腱（けん）２１か所が、顔面の移植には額と左右の眉毛、両耳、鼻、両まぶた、上下の唇、皮膚の下の頭蓋骨や鼻骨、頬骨、顎の骨の一部が含まれる。
　手術には高いリスクがあり、失敗すればディメオさんの状態は悪化して最悪の場合は命に関わる恐れもあったが、無事成功した。ロドリゲス医師によるとリハビリは順調で、ディメオさんはスポーツに取り組みたい、大好きなゴルフをまたやりたいと語っているという。【翻訳編集ＡＦＰＢＢＮｅｗｓ】
〔ＡＦＰ＝時事〕（2021/02/05-11:23）

A 22-year-old man from New Jersey who suffered horrific injuries in a car accident has become the world's first person to undergo a successful face and double hand transplant, his medical team announced Wednesday.
Joe DiMeo sustained third-degree burns on over 80 percent of his body when he fell asleep while driving home from a night shift in July 2018, causing his car to flip over and then explode.
Though he was pulled to safety by a passerby, his injuries included amputated fingertips, severe facial scarring, and the loss of his lips and eyelids -- affecting his vision and ability to lead a normal, independent life.
He remained in a hospital burn unit for four months, where he received numerous grafts and life-saving blood transfusions, and was placed in a medically induced coma for nearly two and a half months.
But DiMeo said he now had a second chance at life and offered a message of hope.
There's always light at the end of the tunnel, never give up, DiMeo said at a press conference organized by NYU Langone Health, which carried out the pioneering procedure that made use of 3D printed cutting-guides.
The surgery was carried out on August 12 of 2020 and lasted approximately 23 hours.
It involved a team of 96 health care personnel, led by surgeon Eduardo Rodriguez, director of the Face Transplant Program at NYU Langone.
All of us unanimously agree that Joe is the perfect patient, said Rodriguez. He's the most highly motivated patient that I've ever met.
It was the fourth face transplant carried out by Rodriguez, and the first hand transplant carried out under his direction.
Two other simultaneous face and hand transplants are known to have been attempted, but both failed. One of the patients died from infection-related complications, while the other required removal of the hands after they failed to thrive.
- Risky procedure -
Finding a donor required a nationwide search akin to finding a needle in a haystack, said Rodriguez.
This was because a test known as a panel reactive antibody revealed he would reject 94 percent of donors, leaving just a six percent chance of a compatible donor.
An exact match was eventually found from the state of Delaware thanks to the Gift of Life Donor Program.
The transplants involved both hands to the mid-forearm, including the radius and ulna bones, three dominant nerves to the hand, six blood vessels requiring vascular connections, and 21 tendons.
The donor's full face was also transplanted, including the forehead, eyebrows, both ears, nose, eyelids, lips, and underlying skull, cheek, nasal, and chin bone segments.
The risky procedure, which could have failed and left DiMeo worse off than before, or even killed him, was a success.
The fine motor skills continued to improve, said Rodriguez. He wants to work on sports, he loves to play golf, and he wants to get back to the course. I'm always impressed by the amount of weight that he can lift and the quality of his grip strength.
DiMeo read from a short statement where he thanked his medical team, family and the sacrifice and selflessness of his unnamed deceased donor.
He compared learning to use his new hands to a baby gripping things for the first time.
The hardest part is knowing that I can do it, but my hands aren't there yet. I've got to keep practicing.