Face transplantation: A longitudinal histological study focusing on chronic active and mucosal rejection in a series with long-term follow-up
| Autor: | Jean-Paul Meningaud, Philippe Grimbert, Laurent Lantieri, Mikael Hivelin, Barbara Papouin, C. Suberbielle, Emilie Sbidian, Maryvonnick Carmagnat, Romain Bosc, Anissa Moktefi, Pierre Wolkenstein, Nicolas Ortonne |
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| Rok vydání: | 2021 |
| Předmět: |
Graft Rejection
medicine.medical_specialty Face transplant Biopsy medicine.medical_treatment Concordance 030230 surgery Gastroenterology 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Immunology and Allergy Pharmacology (medical) skin and connective tissue diseases Transplantation Mucous Membrane integumentary system medicine.diagnostic_test Chronic Active business.industry FOXP3 Kidney Transplantation Concomitant Immunohistochemistry business Facial Transplantation Follow-Up Studies |
| Zdroj: | American Journal of Transplantation. 21:3088-3100 |
| ISSN: | 1600-6135 |
| DOI: | 10.1111/ajt.16489 |
| Popis: | The 2007 Banff working classification of skin-containing Tissue Allograft Pathology addressed only acute T cell-mediated rejection in skin. We report the longitudinal long-term histological follow-up of six face transplant recipients, focusing on chronic and mucosal rejection. We identified three patterns suggestive of chronic rejection (lichen planus-like, vitiligo-like and scleroderma-like). Four patients presented lichen planus-like and vitiligo-like chronic rejection at 52 ± 17 months posttransplant with severe concomitant acute T cell-mediated rejection. After lichen planus-like rejection, two patients developed scleroderma-like alterations. Graft vasculopathy with C4d deposits and de novo DSA led to subsequent graft loss in one patient. Chronic active rejection was frequent and similar patterns were noted in mucosae. Concordance between 124 paired skin and mucosal biopsies acute rejection grades was low (κ = 0.2, p = .005) but most grade 0/I mucosal rejections were associated with grade 0/I skin rejections. We defined discordant (grade≥II mucosal rejection and grade 0/I skin rejection) (n = 55 [70%]) and concordant (grade≥II rejection in both biopsies) groups. Mucosal biopsies of the discordant group displayed lower intra-epithelial GranzymeB/FoxP3 ratios suggesting a less aggressive phenotype (p = .08). The grading system for acute rejection in mucosa may require phenotyping. Whether discordant infiltrates reflect a latent allo-immune reaction leading to chronic rejection remains an open question. |
| Databáze: | OpenAIRE |
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