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

Abstract

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.

Successful Extension of Vascularized Composite Allograft Perfusion Cold Storage to 24 h in a Rat Hindlimb Transplant Model

“…8 This treatment is currently limited due to the high susceptibility of soft tissue to ischemia reperfusion injury (IRI) and lifelong immunosuppression requirement for patients, making recipients prone to opportunistic infections, chronic kidney failure, and many other long-term complications. [9][10][11][12][13][14] To date, relatively few VCA transplants have been performed: approximately 150-200 VCA transplants worldwide. 15,16 Currently, the acceptable ex vivo storage time is limited to 6 h, but the detrimental effects of prolonged ischemic storage can be observed as early as 3 h. [17][18][19][20] As a result, some have advocated the transport of the donor and recipient to the same site to minimize cold ischemia time, which is often logistically challenging, if not impossible, with a multiorgan donor.…”