Groundbreaking Recovery: First-Ever Whole-Eye Transplant Success Story!

In a groundbreaking medical feat, a team of skilled surgeons at NYU Langone Health achieved the unimaginable in May 2023. They completed the first-ever whole-eye and partial-face transplant on 46-year-old Aaron James, a courageous military veteran who overcame the devastating aftermath of a high-voltage electrical accident. Fast forward to today, and Aaron is thriving in Arkansas, embracing life with renewed vigor.

A recent study published in the prestigious Journal of the American Medical Association (JAMA) reveals exciting findings from this remarkable surgery. Remarkably, the transplanted donor eye has maintained healthy pressure and blood flow, defying previous animal studies where eyes often shrank post-transplant. While Aaron hasn’t regained sight yet, electroretinography tests indicate that the light-sensitive nerve cells, crucial for vision, are still intact — a beacon of hope for future advancements in whole-eye transplants aimed at restoring sight.

“The progress we’ve witnessed over the past year is truly promising and sets the stage for future breakthroughs,” shared Dr. Eduardo D. Rodriguez, the lead surgeon and senior author of the study, who spearheaded a team of over 140 dedicated medical professionals. “Aaron’s recovery has been nothing short of miraculous, with no signs of rejection. Our meticulous matching process and tailored immunosuppression regimen have redefined the standards for minimizing early rejection episodes.” Dr. Rodriguez is also the director of the Face Transplant Program and the Laura and Isaac Perlmutter Cosmetic Plastic Surgery Center, as well as the Helen L. Kimmel Professor of Reconstructive Plastic Surgery.

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The JAMA study, led by Dr. Rodriguez and his team from the Hansjörg Wyss Department of Plastic Surgery, along with the Departments of Ophthalmology, Radiology, and NYU Langone’s Transplant Institute, details the 21-hour surgery that utilized cutting-edge microsurgical techniques, custom surgical devices, and innovative cell-based therapies. The procedure made history by being the first to inject stem cells directly into a human optic nerve during the transplant, aiming to enhance nerve regeneration. The team faced significant challenges with this combined whole-eye and partial-face transplant but proved that such procedures can restore vital functions and structures for patients.

Clinical tests conducted over the past year on Aaron’s transplanted eye revealed encouraging results: normal intraocular pressure, good blood flow, and preserved retinal structure. This groundbreaking research promises to pave the way for future advancements.

While Aaron has yet to perceive light, some damage to the optic nerve has resulted in retinal tissue loss during recovery. The authors emphasize that more extensive testing is crucial for reaching definitive conclusions about these initial findings.

“This study is the first to demonstrate the feasibility of whole-eye transplant alongside a face transplant,” stated Dr. Vaidehi S. Dedania, Aaron’s ophthalmologist and a retina specialist. “The results we’re observing are extraordinary and may lead to new clinical protocols, inspiring further exploration into complex transplants involving essential sensory organs.”

A Year of Milestones: Rediscovering Life’s Simple Joys

For Aaron, the past year has been filled with life-changing milestones. From no longer facing unwanted stares to savoring solid meals and enjoying the sweet scent of everyday life, he’s relishing the little things that many take for granted. Most importantly, he’s fully engaged in his role as a father, proudly sending his daughter, Allie, off to college.

“I’m pretty much back to being a normal guy, doing normal things,” Aaron shares. “This year has been the most transformative of my life. I’ve received the gift of a second chance, and I cherish every moment.”

One of the highlights of his journey was a recent trip to the DMV to update his driver’s license. The emotional exchange with the DMV worker, who was moved to tears as Aaron replaced his old license — showcasing his previous injuries — for a new one that reflects his healed self, was a moment to remember.

“The aesthetic outcomes and enhanced quality of life this procedure has given Aaron are monumental,” added Dr. Daniel J. Ceradini, the study’s first author and director of research at the Hansjörg Wyss Department of Plastic Surgery. “He has regained many aspects of life he lost after his injury, and that is our ultimate goal.”

Aaron continues to attend regular follow-up appointments at NYU Langone, feeling honored to be at the forefront of such transformative research. “Being patient zero is a privilege. Even if I can’t see through my new eye, I’ve regained my quality of life, and I know this is a step forward for future patients,” he said.

Charting the Future of Vision Restoration

With over 7 million Americans impacted by vision loss, the quest for effective restoration methods has never been more critical. While various therapies exist to slow the deterioration, none can currently restore sight. Whole-eye transplants have remained a daunting challenge, largely due to the eye’s intricate nature. Key obstacles include ensuring proper retinal blood flow, preventing immune rejection, and fostering the regrowth of nerves and their connections to the brain.

“The initial hurdle was successfully transplanting an entire eye into a human while maintaining its viability—a remarkable feat achieved by Dr. Rodriguez and the NYU Langone team,” stated Dr. Paul W. Glimcher, director of NYU Langone’s Neuroscience Institute. “The next challenge is preserving the nerve cells in the eye during the transplant process. The fact that some retinal components have survived over the past year is truly remarkable. Our ultimate goal is to ensure that all eye cells endure the transplant, establishing essential connections to the brain for vision restoration, as sight fundamentally relies on brain function.”

The human eye connects to the brain via the optic nerve, a vital part of the central nervous system responsible for transmitting visual information. The researchers will continue to navigate this uncharted territory alongside Aaron as they push the boundaries of medical science.

“We’ve successfully accomplished the transplantation of an eye. Now, we must delve deeper to understand how to restore sight,” said Dr. Rodriguez. “We eagerly anticipate progressing this research in collaboration across academic fields to expedite these groundbreaking discoveries using innovative tools and therapies.”

Other contributors to the NYU Langone study include David L. Tran, MD, plastic surgery resident; Dr. Bruce E. Gelb from the Transplant Institute and the Department of Surgery; Dr. Oriana D. Cohen; Dr. Roberto L. Flores; Dr. Jamie P. Levine; Dr. Pierre B. Saadeh; Dr. David A. Staffenberg; Zakia Ben Youss, BTech; Patryk Filipiak, PhD, research scientist; and Dr. Steven H. Baete from the Department of Radiology.

The authors extend their gratitude to all those at NYU Langone who made this monumental endeavor possible; LiveOnNY, the organ procurement organization for the greater New York metropolitan area; DePuy Synthes and Materialise for their support in instrumentation design; LaGuardia Studio at New York University for donor prosthetic printing; and especially the donor and their family for their generous gift of life, and Aaron James for being an incredible patient.

This groundbreaking work was supported by NYU Langone Health and the NYU Grossman School of Medicine, with additional support for magnetic resonance imaging tractography studies from the National Institutes of Health grants RO1 EB028774.

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