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The world's first face transplant recipient, Frenchwoman Isabelle Dinoire, has died "after a long illness", a French hospital announced on Tuesday, amid reports her body started rejecting her face last year.
Ms Dinoire made medical history in 2005 when she received a graft comprising the nose, lips and chin of a brain-dead donor. She required the huge transplant to replace parts of her face that had been mauled by her labrador while she was in a deep slumber after a suicide attempt.
The hospital in Amiens, northern France, confirmed the death of "Mrs D., the first patient in the world to receive a face transplant in an operation carried out by Professor (Bernard) Devauchelle and his teams on November 27, 2005."
The hospital said her death on April 22 had been kept quiet until now to protect her family's privacy.
She died "surrounded by her family", it said.
Le Figaro newspaper reported that Ms Dinoire's body had rejected the transplant last year "and she had lost part of the use of her lips".
The drugs that she had to take to prevent her body from rejecting the transplant left her susceptible to cancer, and two cancers had developed, the report said.
In a news conference in February 2006, just three months after the operation, the blonde, blue-eyed mother of two appeared before TV cameras wearing a black top and pink cardigan.
She appeared to be wearing thick makeup to disguise the scars of the procedure.
Her lips were heavy and hard to move, and she spoke with a pronounced lisp but was otherwise comprehensible.
In the conference, she recounted how she had fainted after "taking medicines to forget" personal problems.
"When I woke up, I tried to light a cigarette and I couldn't understand why it didn't stay between my lips. Then I saw the pool of blood and the dog next to me," she said.
"I went to look in the mirror and was horrified."
But she said that the ground-breaking operation had given her a new lease of life.
"Since my operation I have a face, like everyone... I will be able to resume a normal life," the divorcee said.
"I have been saved. Lots of people write saying that I need to go on, that it's wonderful. It's a miracle somehow," she said.
One week after the transplant, she could eat and chew, and her speech improved rapidly. Four months later, sensation had mostly returned, extending to the edge of one lip.
She went on to learn to speak properly, and to pull a range of expressions which made her feel “completely normal”.
But kissing still remained beyond her.
“I’m battling, I’m continuing to try and get there. When I hear people say I will never get there it makes me even more determined,” she said in a book in 2007.
However, the threat of her body rejecting the transplant hung over her.
The operation was led by Jean-Michel Dubernard, a world-renowned surgeon at Edouard Herriot hospital in the eastern city of Lyon, and Devauchelle, a professor of facial surgery.
Dubernard had performed the world's first hand transplant in September 1998, followed by the first double hand and forearm transplant in January 2000.
The decision to perform the operation sparked a fierce debate over the ethics of the operation.
But Sylvie Testelin, one of the surgeons who performed the operation, said: "It's easy to say we shouldn't have done that, but her life has changed, she goes shopping, goes on holiday
"Before she couldn't live. Before she didn't recognise herself, she scared herself. One can't live like this."
The transplant team came under fire from within the French medical profession for releasing post-operation pictures of the patient.
Since the ground-breaking medical feat, around 30 people have received face transplants around the world.
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