A case of facial composite tissue allograft rejection

Yan, Di; Stokar, Evan; Jacoby, Adam; Gelb, Bruce; Rodriguez, Eduardo D.; Meehan, Shane A

doi:10.1016/j.jdcr.2020.07.004

Cited by 3 publications

(3 citation statements)

References 11 publications

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“…27 Additionally, there are reports in the literature about subclinical rejection where the allograft shows minimal to no signs of erythema. 5,28,29 In our experience, erythema and exanthema are reliably associated with AR beyond the first two years post-transplant, but subclinical rejections are more frequent thereafter. 7 Using the software to assess clinical perception of rejection comparing facial allograft to native skin suggests erythema is a reliable marker of rejection within the first two years posttransplant, validating prior results.…”

Section: Discussionmentioning

confidence: 72%

Software-based Detection of Acute Rejection Changes in Face Transplant

Dorante

Kollar

Bittner³

et al. 2021

J Reconstr Microsurg

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Background An objective, non-invasive method for redness detection during acute allograft rejection in face transplantation (FT) is lacking. Methods A retrospective cohort study was performed with 688 images of 7 patients with face transplant (range, 1 to 108 months post-transplant). Healthy controls were matched to donor age, sex, and had no prior facial procedures. Rejection state was confirmed via tissue biopsy. An image-analysis software developed alongside VicarVision (Amsterdam, Netherlands) was used to produce R, a measure of differences between detectable color and absolute red. R is inversely proportional to redness, where lower R values correspond to increased redness. Linear mixed models were used to study fixed effect of rejection state on R values. Estimated marginal means of fitted models were calculated for pairwise comparisons. Results Of 688 images, 175, 170, 202, and 141 images were attributable to Banff Grade 0,1,2, and 3, respectively. Estimated change in R value of facial allografts decreased with increasing Banff Grade (p = 0.0001). The mean R value of clinical rejection (Banff Grade ⅔) (16.67, 95% Confidence Interval [CI] 14.79–18.58) was lower (p = 0.005) than non-rejection (Banff Grade 0/1) (19.38, 95%CI 17.43–21.33). Both clinical and non-rejection mean R values were lower (p = 0.0001) than healthy controls (24.12, 95%CI 20.96–27.28). Conclusion This proof-of-concept study demonstrates that software-based analysis can detect and monitor acute rejection changes in FT. Future studies should expand on this tool's potential application in telehealth and as a screening tool for allograft rejection.

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Section: Discussionmentioning

confidence: 72%

Software-based Detection of Acute Rejection Changes in Face Transplant

Dorante

Kollar

Bittner³

et al. 2021

J Reconstr Microsurg

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“…These include dermal sclerosis encasing the dermal capillaries, sweat gland atrophy, lichenoid changes. [16][17][18] and capillary thrombosis in the upper dermis, with a dense perivascular infiltrate 19 which are thought to be signs of chronic rejection. Etra et al proposed a VCA skin rejection classification in swine which they called the "modified Banff criteria."…”

Section: Discussionmentioning

confidence: 99%

“…These include dermal sclerosis encasing the dermal capillaries, sweat gland atrophy, lichenoid changes. 16–18 and capillary thrombosis in the upper dermis, with a dense perivascular infiltrate 19 which are thought to be signs of chronic rejection. Etra et al proposed a VCA skin rejection classification in swine which they called the “modified Banff criteria.” 20 This focused only on infiltrating inflammatory cells leading to dermal inflammation and largely epidermal involvement focusing on inflammation followed by necrosis.…”

Section: Discussionmentioning

confidence: 99%

Immunohistochemical Analysis of Lymphocyte Populations in Acute Skin Rejection: The University Health Network Addition to the Banff Classification

Haykal

Barone

Rostami

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: Acute rejection in vascularized composite allotransplantation has been identified using the Banff 2007 working classification. We propose an addition to this classification based on histological and immunological assessment within the skin and subcutaneous tissue. Methods: Biopsies from vascularized composite transplant patients were obtained at scheduled visits and whenever skin changes occurred. Histology and immunohistochemistry were performed on all samples, looking at infiltrating cells. Results: Observations were made specifically related to each component of the skin, including the epidermis, dermis, vessels, and subcutaneous tissue. Our findings led to the establishment of the University Health Network addition of skin rejection. Conclusions: The high rate of rejection where the skin is involved requires novel techniques for early detection. The University Health Network skin rejection addition can serve as an adjunct to the Banff classification.

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