Carmen Blandin Tarleton yearned for a new face. Hers had been burned beyond recognition in a vicious attack by her estranged husband, who forced his way into her home late one night and doused her body with a powerful lye.
But there was a roadblock: Because Tarleton had received dozens of blood transfusions in the days following the June 2007 assault, her immune system was on high alert and would surely reject a face transplanted from a donor.
Surgeons at Brigham and Women’s Hospital proposed an untested approach that they believed would cut the risk of rejection. But as they awaited approval from a hospital committee, they received word that a donor family had come forward. The donor was not a perfect match, however, making the transplant riskier than usual. Doctors had just hours to make a decision.
Tarleton, a 44-year-old former transplant nurse, wanted to take the gamble.
“I talked to Carmen about this being acceptable but higher risk,’’ Dr. Bohdan Pomahac, director of plastic surgery transplantation at the Brigham, said in an interview. “She said, ‘I know if this whole thing fails, you will be able to patch me up.’ ”
A team of 30 surgeons performed the 15-hour transplant operation earlier this month. The hospital’s fifth face transplant, it was the most complex so far. The problem doctors feared — that Tarleton’s sharpened immune system would attack her new face — occurred five days after surgery when the donor skin swelled and turned red.
But Pomahac said doctors were able to reverse the rejection with a new drug.
“She is in great spirits,’’ he told reporters during a press conference at the hospital Wednesday. “She’s one of the most inspirational people I have ever met.’’ He said her face “looks amazing.”
Tarleton watched a webcast of the press conference from her hospital room and blogged afterward.
“I could never have imagined the overwhelming feelings I encountered after my surgery,’’ she wrote on her blog, describing the relief she felt with the removal of painful scars that had severely restricted movement of her head. “I could freely move my head from side to side without the usual scar discomfort I have felt for almost six years now. I cried with such a deep appreciation for the persons truly responsible for giving me this gift: this new physical freedom . . . Thank you, thank you, thank you.’’
Tarleton titled a second blog entry simply “Forgiveness . . . ’’
The hospital did not disclose the date of the surgery to protect the identity of the donor, whose family wants to remain anonymous. Like Tarleton, who has two grown daughters, the donor was a mother, who in a statement released by her family was described as having “a radiant smile that would brighten your day.’’
Surgeons transplanted the woman’s facial skin, nose, lips, muscles, arteries, and nerves as well as her neck, making Tarleton’s transplant the largest so far at the hospital.
Pomahac told reporters that he is “still very cautious about what could go wrong,’’ but that he grows more optimistic every day. He said Tarleton should be able to return home to Vermont soon.
She likely will feel sensations in her new face in about three months and be able to move her nose, lips, and other muscles in six months, he said.
On the day of the attack in 2007, Tarleton was at home in Thetford with her two girls — Liza, then 14, and Hannah, then 12 — when Herbert Rodgers forced his way inside. After battering her head with a baseball bat, he squirted industrial-strength lye from a dish-soap bottle onto her arms, legs, back, and face, burning over 80 percent of her body and leaving her legally blind. (Tarleton is blind in her right eye but can see somewhat with her left eye and read with a magnifier.)
According to police accounts, Rodgers plotted the attack after learning that Tarleton was seeing another man. He was later sentenced to a 30- to 70-year prison term after pleading guilty to a charge of maiming.
Within hours of the assault, Tarleton was flown to the Brigham, where she underwent 38 surgeries over the next three months.
“Her injuries were among the worst I’ve seen in my career,’’ Pomahac said. “She was unrecognizable to anyone who knew her.’’
After doctors performed a partial face transplant on James Maki of Fitchburg in 2009 — the first face transplant at the hospital and the second such transplant performed in the United States — Tarleton became eager for the surgery. Doctors placed her on the waiting list in December 2011.
But because she had so many blood transfusions and skin transplants, her body had produced many antibodies against foreign cells. Similar to what occurs when people receive vaccines, these antibodies were then primed to attack foreign cells and tissue even more aggressively.
Pomahac said Tarleton was frustrated with the wait for a donor, so he and his team proposed a special approach to the hospital’s ethics committee “to enhance her chances.’’ It included a dialysis-like procedure that would filter the antibodies out of her blood as well as giving her drugs to suppress her immune system before the transplant.
During an interview with the Globe in September, Tarleton said her family originally opposed a transplant because they did not want her appearance to change again. But she said it was too difficult living with a face that was barely functional. “It’s easy to forget how little of a face I have that works,’’ she said at the time. “I can’t let that go.”
When the donor’s family came forward, doctors “kept going back and forth,’’ Pomahac said Wednesday. Tarleton’s willingness was crucial, as was the realization that “she was not likely to find a better match,’’ he said.
Doctors were allowed to put in place one aspect of the new protocol: When Tarleton experienced acute rejection of the transplanted face, they gave her a dose of a special, expensive “rescue drug,’’ which the hospital had agreed to pay for.
Pomahac said Tarleton likely will require high doses of anti-rejection medication for the rest of her life, unlike Maki and the other previous transplant patients.
In 2011, Pomahac and the team performed the first full face transplant in the United States, on Dallas Wiens of Texas. The other two recipients were Mitch Hunter and Charla Nash. All four are doing well, Pomahac said.Liz Kowalczyk can be reached at firstname.lastname@example.org.