The First Successful Whole-Eye Transplant, Over A Year Later

KATHLEEN DAVIS: This is Science Friday. I’m Kathleen Davis, sitting in for Ira Flatow. A bit later in the hour, we’ll answer your questions about the new COVID boosters and talk about how songbirds work together during migration. But first, last year, there was a massive milestone in the world of organ transplantation– the first whole human eye, along with a partial face transplant.

At the time, it was unclear how this operation would go. There had never before been a successful transplant of an entire human eye. Now, more than a year later, a new paper in the journal JAMA discusses the success of this first-of-its-kind transplant and the implications this could have for the future of eye surgery. Joining me now is that study’s first author, Dr. Daniel Ceradini, director of research at New York University Langone Department of Plastic Surgery. Welcome to Science Friday. Thanks so much for being here.

DANIEL CERADINI: Yeah, thanks for having me.

KATHLEEN DAVIS: So let’s start here by talking about the man who’s at the center of this story, Aaron James, who received this transplant. Tell me a little bit about him.

DANIEL CERADINI: So Aaron James is a veteran. He’s an army veteran who was working at his job. He’s a– he works on high voltage electrical poles. And during one of his job assignments, he was– unfortunately came in contact with a high-voltage electrical wire, which caused significant injury to his face and one of his arms. And he was airlifted from the site to a specialized regional center for acute care.

The high-voltage electrical injury damaged the lower half of his face, his eye, his nose was gone, and he couldn’t move his jaw. So he couldn’t eat properly, couldn’t smell, therefore, he couldn’t really taste anything. And so it markedly impacted his quality of life. And so after recovering from these injuries, he presented to our multidisciplinary clinic at NYU, where he was evaluated for a face and potentially an eye transplant.

KATHLEEN DAVIS: So walk me through just how extensive this transplant was that you and your team performed.

DANIEL CERADINI: So as with most face transplants, it’s a pretty complicated procedure. The transplant that Aaron had basically replaced mostly the left side of his face and a little bit of his temple region, as well as parts of the right side of his face. In addition to that, because he had lost his eye, we replaced it with the eye from the donor.

And so the tissues that were included skin, muscles that move or drive the face for facial expression, allow you to speak and express your emotion, but also included the bones of the orbit or the eye socket– basically that support the eye and allow it to be stable enough to move and to function. We also took the nose from the donor to replace Aaron’s damaged nose– that was nonexistent actually at that point– and part of the chin to support the facial structures. So there was a lot of tissue involved. And then obviously also the eye and all the delicate musculature, and the nerves, and the blood vessels, that supply the eye were also taken in the donor allograft.

KATHLEEN DAVIS: And so this is my– it’s my understanding that this was the first whole eye transplant on a human ever. Is that right?

DANIEL CERADINI: Yes, that’s correct. It was the first successful reported whole eye transplant in humans.

KATHLEEN DAVIS: And so was there a lot of doubt that this would be successful?

DANIEL CERADINI: There was a ton of doubt. There was an exceptional amount of doubt and no one had any precedent for it. No one knew what was going to happen. I mean, we have a lot of experience in facial transplantation and blood supply to the face and facial structures, so we were pretty confident in that aspect of things. But as far as the eye was concerned, it never really had been done successfully in humans. And it’s always been considered the holy grail for vision restoration.

And so after a lengthy discussion with Aaron and the whole informed consent process for a novel surgery is unique and that– we can’t really offer like– we can offer reasonable expectations, but we can’t offer any definitive data because it’s never been done in a human before about how the outcomes would be. So we had some hope that we would get some function in the eye following transplantation, but we really didn’t know what was going to happen.

KATHLEEN DAVIS: And so why is it so hard? What are the biggest challenges with transplanting an eye?

DANIEL CERADINI: Well, the eye is– there’s– the eye is, obviously, a very delicate organ. It’s an extension of the CNS, or the Central Nervous System, and so it contains nerves, particularly in the retina, which transduce signals from light and then converts them to an electrical signal and then transmits them through the optic nerve back to the brain.

And so that delicate nervous connection to the brain is really, really, really sensitive to injury and a lack of blood supply. And so the process of transplantation– you’re removing the entire allograft from the donor blood supply and it’s outside the body for a certain length of time and then needs to be retransplanted and have circulation restored in the recipient. And so it’s that window of having no blood supply– it’s a race against time to prevent the nerves from dying.

KATHLEEN DAVIS: And so what is the status of Aaron’s new eye now that we’re more than a year after the surgery?

DANIEL CERADINI: So the status of this new eye is that it’s completely viable and something that we had hoped would happen but did happen. His retina has complete perfusion, which means the blood supply supplies all parts of the retina as we would have hoped. In addition to that, his eye actually, when you shine light into it, it converts it to an electrical signal, which is really huge– is a huge step for bringing eye transplantation for vision restoration to a reality. And so it generates an electrical signal.

And based on preliminary data, it may communicate with the brain. It’s very preliminary, though, so you can’t really definitively say whether that is actually happening in Aaron or not. I can tell you that he does not have sight in his eye. But, again, since this is– has never been done before, there’s no precedent for it in humans, it’s unclear when, or how, or how long it will take for something to happen on the order of him regaining at least light perception.

KATHLEEN DAVIS: So even though Aaron can’t see out of his new eye, you are still considering this a success, right?

DANIEL CERADINI: Well, it’s– yeah, it’s definitely a success in the sense that it’s a milestone procedure in order to move the whole field of sight restoration through transplantation forward. It’s the first time that we’ve successfully gotten the eye to live, so to speak, with a living retina. And not all of the cells of the retina survived, but some of them did. And so that’s hopeful and will be a platform to build on to incorporate other innovations in science to maintain the optic nerves so that they survive the transplant. And so, in that sense, I consider it a success for sure.

KATHLEEN DAVIS: Do you have hopes that this eye might actually regain some of the abilities that have been lost? Is that even a possibility as far as we know?

DANIEL CERADINI: I think it’s a very remote possibility, to be honest. And we knew that going in. I think the best case scenario would be for him to regain some light perception– some very gross light perception, where he can just sense the lights on or lights off. But I think to envision him being able to read text on a paper or something like that with the transplanted eye is a little bit unreasonable at this point. Again– but we have no idea what’s going to happen, so the study of Aaron and his transplanted eye over time is going to be very important to figure out how to make this happen.

KATHLEEN DAVIS: So as we’ve been talking about, this is a huge milestone. What does this success tell you about the future of eye transplants?

DANIEL CERADINI: I think the future is bright, no pun intended, that this is a platform, again, to build on. And so the technical challenges of actually getting the blood supply to the eye, which is supplied by a very small artery, which is in a completely different circulation than the face– that technical challenge and being able to procure the allograft from the donor safely without damaging all these structures was a huge technical milestone. And so having that as a platform to build on and incorporate things that help the nerve regenerate and preserve it during the transplantation procedure– I think all these things are going to accelerate relatively quickly.

KATHLEEN DAVIS: Vision loss affects millions of Americans each year. So it seems like eye transplantation, if we can get it right, could be hugely beneficial. I mean, do you eventually see that coming into reality where this could be an option for people?

DANIEL CERADINI: Yeah, I see it as a reality. I just don’t know what time horizon we’re looking at. I think it’s going to take a little bit of time because the optic nerve regeneration is going to be a critical step– the next critical step that we need to solve. And while there are a lot of bright people working on it and we’re collaborating with a lot of them, I think that is probably the key to getting this to actually be more of a functional eye.

But I absolutely believe that it’s going to be a reality at some point. It’s going to move in increments. Obviously, this is going to be limited to select populations first and then eventually– hopefully, in my lifetime– this will be available to people that suffer from blindness from nontraumatic causes.

KATHLEEN DAVIS: So, to me, it almost seems like this is a very multidisciplinary field. You have people working on the optic nerve side of things, you have the surgery side of things. I mean, what other components are in this that need support to make this a reality?

DANIEL CERADINI: Well, even in our own study, we had– we have ophthalmologists, we have– we’re plastic and reconstructive surgeons, we have transplant surgeons, we have neurologists, we have radiologists that help us determine how and if the optic nerve is reconnecting. You can imagine that, ultimately, the basic science side or the translational science side of things is going to integrate into this platform. And so you’ll have all the basic scientists that are at the neuroscience institute at NYU, for instance.

All those basic science innovations can be more rapidly translated into humans now that we’ve actually done it in humans, it’s not– it’s no longer just an animal model that you have to look at. And, again, this will happen incrementally and it’s not going to happen at lightning speed quite yet. But this, again, opens the opportunity for us to incorporate these into our protocol.

KATHLEEN DAVIS: So circling back to Aaron and his role in all of this, have you heard from him about how his quality of life has changed since this procedure?

DANIEL CERADINI: Yeah, I mean, obviously, Aaron would be the best person to speak to about that. But every time we see him, he reports having a tremendous increase in his quality of life. And we measure it objectively, but it’s hard to do that objectively. It’s– I think it’s more valuable to actually speak to him, but, yes, he has related to us that he has a tremendous increase in his quality of life to the point where he’s recognizing his allograft as his own now and his face looks somewhat foreign to him.

The fact that he can eat, and smell, and feel his face– all these things improve quality of life, for sure. And even though he doesn’t have sight, I think the surgery was a success in that sense as well in that you really changed his life for the better, obviously. And as a as a recipient, he takes on a certain amount of risk to do that. And the fact that he was willing to do this, and be the first eye transplant recipient, and allow us to learn from him is really a testament to his character.

KATHLEEN DAVIS: Well, that is all the time that we have for now. I’d like to thank my guest, Dr. Daniel Ceradini, director of research at New York University Langone’s Department of Plastic Surgery. Thanks so much for talking about this with us today.

DANIEL CERADINI: Thanks, it was great talking with you.

Copyright © 2024 Science Friday Initiative. All rights reserved. Science Friday transcripts are produced on a tight deadline by 3Play Media. Fidelity to the original aired/published audio or video file might vary, and text might be updated or amended in the future. For the authoritative record of Science Friday’s programming, please visit the original aired/published recording. For terms of use and more information, visit our policies pages at http://www.sciencefriday.com/about/policies/