Lymphadenopathy and lymph node rejection following facial vascularized composite allotransplantation.

Autor: Kauke-Navarro M; Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, USA., Sadigh S; Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Lee CAA; Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Panayi AC; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Knoedler L; Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, USA., Knoedler S; Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, USA; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Stoegner V; Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, USA; Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Burn Center, Hannover Medical School, Hannover, Germany., Huelsboemer L; Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, USA., Jamil A; Department of Medicine, Transplantation Research Center, Renal Division, Brigham and Women's Hospital and Children's Hospital, 221 Longwood Ave, Boston, MA, USA., Ko C; Department of Pathology, Yale School of Medicine, New Haven, CT, USA., Lian CG; Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Murphy GF; Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Pomahac B; Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, USA. Electronic address: bohdan.pomahac@yale.edu.
Jazyk: angličtina
Zdroj: Journal of plastic, reconstructive & aesthetic surgery : JPRAS [J Plast Reconstr Aesthet Surg] 2024 Apr; Vol. 91, pp. 268-275. Date of Electronic Publication: 2024 Feb 07.
DOI: 10.1016/j.bjps.2024.02.024
Abstrakt: Background: Apart from the skin, little is known about the immunological processes in deeper tissues, which are typically not accessible to biopsy and inspection, of vascularized composite allografts (VCAs). Face transplant patients develop prominent adenopathy shortly after transplantation that resolves over time. The mechanisms underlying this process are not understood.
Materials and Methods: A retrospective cohort study was conducted on 9 patients who underwent 10 facial VCAs at the Brigham and Women's Hospital, Boston, MA, between April 2009 and July 2019. Clinical, radiological, and histological data related to lymphadenopathy of the head and neck were reviewed.
Results: Patients who received donor-derived lymph nodes (LNs) developed bilateral lymphadenopathy of the submental or submandibular superficial LNs. Median time of presentation was POD18 (range POD6-POM3). Notably, bilateral adenopathy of the neck was not observed in later stages of follow-up (mean follow-up, 115 months). Histology of 3 LNs showed increased histiocytes and apoptosis, with the features reminiscent of necrotizing histiocytic lymphadenitis, and B and T lymphocytes (mostly CD8 + T) admixed with CD163 + histiocytes and dendritic cells. Molecular chimerism analysis in one case showed the coexistence of donor (81%) and recipient (19%) derived lymphocytes. Granzyme B (GZMB) expression confirmed the presence of increased cytotoxic T cells in this LN sample.
Conclusion: Our data suggested the involvement of an immunological process within the donor-derived LNs after facial allotransplantation between the recipient and donor cells. GZMB expression suggested LN rejection that can occurred independently of skin rejection. This finding supports the need to better define the role of donor-derived immune cells in the context of allograft rejection.
Competing Interests: Declaration of Competing Interest None declared.
(Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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