顔面移植手術の光と影 世界初の女性が死亡するまでに

「私のことを見て、顔面移植を受けたのだとは、決して思わないでしょう」

フランスのアミアン大学病院は9月6日、2005年に世界初の顔面移植手術を受けたフランスの女性イザベル・ディノワールさんが4月に亡くなったと発表した。49歳だった。

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この写真はイザベル・ディノワールが39歳の時のもので、顔面移植を受けた1年後のものだ。

アミアン大学病院の発表によると、ディノワールさんは長期療養後、家族に看取られて亡くなったという。遺族が喪に服している間は公表しないことを希望したため、死亡当時は発表されなかったと説明した。

病院は死因の詳細を発表しなかったが、AFP通信によると、2016年はじめにディノワールさんの体が移植に拒絶反応を示し、口唇が一部使えなくなったという。ル・フィガロ紙によると、移植への拒絶反応を抑えるために受けていた治療で、2種類のがんにかかったとみられる。

ディノワールさんは38歳のとき、眠っている間に飼い犬に引きちぎられて顔の半分を失った。2005年、フランスの外科医ベルナール・ドゥヴォシェル氏とジャン=ミシェル・デュベルナール氏によって15時間に及ぶ手術が行われた。術後約3カ月経って行われた記者会見で、ディノワールさんはテレビカメラの前で話したり、笑ったり、プラスチックのカップで飲み物を飲み、見ている人たちを驚かせた

「私はまたみなさんと同じように、普通の顔を持つことができました」と彼女は述べ、同時にこう語った。「口を開けて食べることができます。ここ数日で唇、鼻、口の感覚を感じることができるようになりました」

■ ディノワールさんが遺した医学的遺産

ディノワールさんの驚くべき成功事例は、世界中で顔面移植を受けようとしていた多くの患者の運命を変えた。これまで40人弱の患者が顔面移植を受けたが、ディノワールさんのケースのように、長期生存率や手術が心理面に及ぼす影響についてはまだ疑問が残っている。

最近公表された7件の顔面移植患者に関する長期調査によると、患者たちは手術後さまざまな経過をたどっている。患者2人は死亡した。1人は手術後2カ月に移植の失敗による感染症で、もう1人は移植3年後自殺した。生存している患者は繰り返し拒否反応の発症に苦しみ、移植の拒否反応を防ぐために多量のステロイド投与を余儀なくされた。これにより高血圧と腎臓機能低下を起こした可能性がある。

全ての患者とその家族が新しい顔を受け入れたと述べた一方、全員が手術後の社会生活の改善やコミュニティへの融合ができなかったと言っている。しかし、これは事前の精神状態に依拠している可能性があることに注意しなくてはならない。例えば、調査に含まれる4人の患者は、自らの顔面に発砲して負傷したために移植を必要とした。

顔面移植手術の結果や予後は、長期的な観点から見れば実に様々だ。それでも明らかになっているのは、この手術が、何人かの人たちの人生を、より良い方へと変えてきたということだ。これは、ミシシッピ州の消防士だったパトリック・ハーディソンさんについても当てはまるようだ。ハーディソンさんは、家屋の火災現場に出動した際に重度の火傷を負ってから、14年後に顔面移植を受けた。

「今では、私は道を歩いている、ただの普通の人なのです」と、ハーディソンさんは話した。手術から1年が経った2016年、CBSのジョン・ラポック医師によって行われたインタビューで彼は語る。

「人は私のことを見て、何かが起きたんだ、とは思うかもしれません。でも、私のことを見て、顔面移植を受けたのだとは、決して思わないでしょう」

ディノワールは2012年にBBCが行ったインタビューの中で、顔の一部を提供してくれた女性に対して心から感謝し、この匿名のドナーが自分の人生を救ってくれたのだと話した。

「鏡を覗き込むと、(私たち)2人の入り混じったものが見えるのです」と、ディノワールさんはBBCに話した。「このドナーは、いつも私と一緒にいてくれます」

また、ディノワールはこのBBCに、いつか、ドナーの家族に会えるよう願っているとも述べた。

「落ち込んだ時、あるいは憂鬱な時、私は鏡の中に写る自分をまた見て、彼女のことを考えるのです」と、ディノワールさんは言う。「そして、自分自身に伝えるのです。私に諦めることは許されない。彼女は私に希望をくれたのだ、と」

ハフポストUS版より翻訳・加筆しました。

▼画像集が開きます

イザベル・ディノワールさん
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Isabelle Dinoire who received the world's first partial face transplant addresses a news conference at Amiens hospital in France in Amiens, France on February 06th, 2006.(05 of17)
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FRANCE - FEBRUARY 06: Sylvie Testelin (surgeon) and Isabelle Dinoire in Amiens, France on February 06th, 2006. (Photo by Franck CRUSIAUX/Gamma-Rapho via Getty Images) (credit:Franck CRUSIAUX via Getty Images)
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FRANCE - FEBRUARY 06: Isabelle Dinoire who received the world\'s first partial face transplant addresses a news conference at Amiens hospital in Amiens, France on February 06th, 2006. (Photo by Franck CRUSIAUX/Gamma-Rapho via Getty Images) (credit:Franck CRUSIAUX via Getty Images)
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(FILES) - Combo of pictures (dated, at L(09 of17)
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(FILES) - Combo of pictures (dated, at L 06 February 2006, at R from November 2006) of French Isabelle Dinoire, 39, a few months after her surgery operation carried out jointly by an Amiens and Lyon team who underwent the world\'s first facial face transplant, and a year later. When Isabelle Dinoire received the transplant, doctors warned she might never be able to kiss again. Now the 40-year-old French woman can eat, speak and smile normally, according to \'Isabelle\'s Kiss,\' a book on her odyssey released this week. Mixing narrative and interviews with Dinoire, the book takes the reader from the day the young woman was rushed to hospital in May 2005 after being disfigured by her dog, to the press conference the following February at which she revealed her new face to the world. AFP PHOTO DENIS CHARLET (L) AFP PHOTO-CENTRE HOSPITALIER UNIVERSITAIRE AMIENRS (CHU AMIENS) (R) (Photo credit should read DENIS CHARLET/AFP/Getty Images) (credit:DENIS CHARLET via Getty Images)
Isabelle Dinoire who received the world's first partial face transplant addresses a news conference at Amiens hospital in France in Amiens, France on February 06th, 2006.(10 of17)
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FRANCE - FEBRUARY 06: Isabelle Dinoire who received the world\'s first partial face transplant addresses a news conference at Amiens hospital in Amiens, France on February 06th, 2006. (Photo by Franck CRUSIAUX/Gamma-Rapho via Getty Images) (credit:Franck CRUSIAUX via Getty Images)
Isabelle Dinoire who received the world's first partial face transplant addresses a news conference at Amiens hospital in France in Amiens, France on February 06th, 2006.(11 of17)
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FRANCE - FEBRUARY 06: Isabelle Dinoire who received the world\'s first partial face transplant addresses a news conference at Amiens hospital in Amiens, France on February 06th, 2006. (Photo by Franck CRUSIAUX/Gamma-Rapho via Getty Images) (credit:Franck CRUSIAUX via Getty Images)
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Isabelle Dinoire, the woman who received the world\'s first partial face transplant with a new nose, chin and mouth, in an operation on Nov. 27, 2005, addresses reporters during her first press conference since the transplant at the Amiens hospital, northern France Monday Feb. 6, 2006. The 38-year-old woman was mauled by a dog in May, leaving her with severe facial injuries that her doctors said made it difficult for her to speak and eat. (AP Photo/Michel Spingler) (credit:ASSOCIATED PRESS)
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** FILE ** Isabelle Dinoire the woman who received a new nose, chin and mouth in a groundbreaking transplant operation on Nov. 27 addresses reporters during her first press conference after the transplant, at the hospital in Amiens, Northern France in this file photo from Feb. 6, 2006. The 38-year-old woman was mauled by a dog in May, leaving her with severe facial injuries that her doctors said made it difficult for her to speak and eat. (AP Photo/Michel Springer FILE) (credit:ASSOCIATED PRESS)
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Isabelle Dinoire, left, the woman who received the world\'s first partial face transplant last Nov. 27, 2005, looks at a photography of her face taken after surgery, displayed on a screen, as French surgeon Jean-Michel Dubernard, right, looks on, during her first appearance at a press conference since the November surgery at the Amiens Hospital, northern France, Monday Feb. 6, 2006. Dinoire\'s speech was heavily slurred and difficult to understand, but she explained how she was disfigured by a dog bite last year and she thanked the family of the donor who gave her new lips, a chin and nose. (AP Photo/Francois Mori) (credit:ASSOCIATED PRESS)
FRANCE TRANSPLANT(15 of17)
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Isabelle Dinoire (L), who received the world\'s first partial face transplant, looks at a a screen, showing her face immediately after the operation, during a news conference at Amiens hospital in northern France February 6, 2006. Dinoire spoke on Monday for the first time to reporters since her operation, saying she was thankful to have the opportunity for a new start in life. In a 15-hour operation surgeons used tissues, muscles, arteries and veins from a brain-dead woman to rebuild Dinoire\'s face. Dinoire, who was mauled by a dog last May, is from the Lille area in northeastern France. REUTERS/Pascal Rossignol (credit:Pascal Rossignol / Reuters)
FRANCE TRANSPLANT(16 of17)
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Isabelle Dinoire who received the world\'s first partial face transplant addresses a news conference at Amiens hospital in northern France February 6, 2006. Dinoire spoke on Monday for the first time to reporters since her operation, saying she was thankful to have the opportunity for a new start in life. In a 15-hour operation surgeons used tissues, muscles, arteries and veins from a brain-dead woman to rebuild Dinoire\'s face. Dinoire, who was mauled by a dog last May, is from the Lille area in northeastern France. REUTERS/Pascal Rossignol (credit:Pascal Rossignol / Reuters)
FRANCE(17 of17)
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Isabelle Dinoire (R), who received the world\'s first partial face transplant, attends a news conference with Doctor Sophie Testin at Amiens hospital in northern France February 6, 2006. Dinoire spoke on Monday for the first time to reporters since her operation, saying she was thankful to have the opportunity for a new start in life. [In a 15-hour operation surgeons used tissues, muscles, arteries and veins from a brain-dead woman to rebuild Dinoire\'s face. Dinoire, who was mauled by a dog last May, is from the Lille area in northeastern France.] (credit:Pascal Rossignol / Reuters)

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