Risk of Graft Failure/Rejection
With regards to graft failure due to microvascular complications, the risk is less than 5% in the hands of an experience, microvascular surgeon. The risk of acute graft rejection is around 10% and chronic graft rejection is 30-50% as estimated from other solid-organ transplant studies. Other studies have reported that about 85% of all face transplant patients have incurred at least one episode of acute skin rejection within the first year and about 56% of patients have experienced multiple episodes.
Risk of Life-long Immunosuppression
Immunosuppression post-transplant is necessary to prevent the host immune system from attacking the transplanted graft. This, however, carries its own risks. Immunosuppressive medications have side effects that can cause hypertension, renal toxicity, diabetes, and blood lipid levels. Patients are also at risk of infections and malignancy. Squamous cell carcinoma of the skin will eventually develop in half of all organ transplant patients on immunosuppression. Patients are advised to avoid sunlight and are regularly screened for new lesions. In 2% of patient can also develop post-transplant lymphoproliferative disease, which ranges from fevers to highly malignant lymphoma. Treatment requires reduction of immunosuppressive therapy, but this can lead to eventual graft loss. In the long term, research is underway to induce immunologic tolerance in the host such that their immune system does not attack the graft, eliminating the need for long term immunosuppressive medications.