The Banff 2007 Working Classification of Skin-Containing Composite Tissue Allograft Pathology

Cendales, Linda C.; Kanitakis, Jean; Schneeberger, S.; Burns, Carolyn D.; Ruiz, Philip; Landín, Luis; Remmelink, Myriam; Hewitt, Charles W.; Landgren, T; Lyons, Bruce; Drachenberg, C. B.; Solez, Kim; Kirk, Allan D.; Kleiner, David E.; Racusen, Lorraine C.

doi:10.1097/01.tp.0000330475.71807.b7

Cited by 66 publications

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“…8 Rejection in all patients coincided with development of clinical signs and shared the following histopathologic features: perivascular lymphoid infiltrates with evidence of endothelial injury that included cell sloughing into vessel lumens ('lymphocytic vasculitis'); lymphocyte migration into the epidermis and into pilosebaceous structures; and epithelial apoptosis spatially associated with infiltrating lymphocytes (this latter feature qualifying for Banff grade III ( pilosebaceous units (Figure 2a). Biomarkers directed against donor and recipient histocompatability antigens were remarkable in that the majority (490%) of lymphoid cells infiltrating the epidermis and pilosebaceous epithelium were donor derived in all three patients so studied (Bw4 positive and B7 negative in patients 2 and 5, and Bw4 negative in patient 3; Figures 2 and 3).…”

Section: Resultsmentioning

confidence: 99%

“…8 The Banff working classification is also used for diagnosis and grading of renal allograft pathology, where recently cited limitations include lack of formal incorporation of morphology, molecular, and genomic approaches. 31 For skin and soft tissue vascular composite allotransplantation, the Banff classification focuses primarily on extremity and abdominal allografts that are not entirely relevant to the microanatomical, immunologic, and dermatitic milieu of facial skin and soft tissue.…”

Section: Discussionmentioning

confidence: 99%

“…With the recent advent of fullfacial transplantation, 7 detailed and sequential histopathologic surveillance for rejection in a manner seldom feasible for conventional skin allografts has become a necessity. However, existing schemas 8 for histologic recognition and grading of rejection in vascular composite allotransplantation are based primarily on allografts that may express relevant structural and immunological differences from facial tissues, eg, extremities (hand) and abdominal wall transplantations. Moreover, precise understanding of immune cell phenotypes that participate in rejection phenomena in this emerging frontier remains incomplete.…”

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confidence: 99%

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Biomarker evaluation of face transplant rejection: association of donor T cells with target cell injury

et al. 2014

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This series of 113 sequential biopsies of full facial transplants provides findings of potential translational significance as well as biological insights that could prompt reexamination of conventional paradigms of effector pathways in skin allograft rejection. Serial biopsies before, during, and after rejection episodes were evaluated for clinicopathological assessment that in selected cases included specific biomarkers for donorversus-recipient T cells. Histologic evidence of rejection included lymphocyte-associated injury to epidermal rete ridges, follicular infundibula, and dermal microvessels. Surprisingly, during active rejection, immune cells spatially associated with target cell injury consisted abundantly or predominantly of lymphocytes of donor origin with an immunophenotype typical of the resident memory T-cell subset. Current dogma assumes that skin allograft rejection is mediated by recipient T cells that attack epidermal targets, and the association of donor T cells with sites of target cell injury raises questions regarding the potential complexity of immune cell interactions in the rejection process. A more histopathologically refined and immune-based biomarker approach to assessment of rejection of facial transplants is now indicated. Modern Pathology (2014) 27, 788-799; doi:10.1038/modpathol.2013.249; published online 17 January 2014Keywords: donor T cell; facial transplant; graft-versus-host disease; skin allograft; T resident memory cells; vascularized composite allotransplantation Recent reports emphasizing the critical therapeutic importance of accurate diagnosis of transplant rejection 1 have stressed the imminent need for more precise clinicopathologic criteria and complementary application of relevant biomarkers. 2 The first systematic studies of any form of human allograft rejection were reported by Gibson and Medawar 3 in their classic description of skin rejection involving wartime aviators. 4 Early clues regarding the immunologic basis of skin graft rejection came from studies by Dvorak et al 5 and Bhan et al 6 that implicated both CD4 þ and CD8 þ T cells. These T-cell populations were presumed to be of recipient origin and considered to be primary effectors of epidermal and dermal microvascular target cell injury. With the recent advent of fullfacial transplantation, 7 detailed and sequential histopathologic surveillance for rejection in a manner seldom feasible for conventional skin allografts has become a necessity. However, existing schemas 8 for histologic recognition and grading of rejection in vascular composite allotransplantation are based primarily on allografts that may express relevant structural and immunological differences from facial tissues, eg, extremities (hand) and

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Biomarker evaluation of face transplant rejection: association of donor T cells with target cell injury

et al. 2014

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“…Samples were fixed in 10% neutral buffed formalin, sectioned and stained with hematoxylin and eosin (H&E) for microscopic examination. All slides were blinded and read by a transplant pathologist and all sections were scored for AR based on an established standard AR grading scale (26).…”

Section: Histopathologymentioning

confidence: 99%

Spontaneous Resolution of Acute Rejection and Tolerance Induction With IL-2 Fusion Protein in Vascularized Composite Allotransplantation

Jindal

Unadkat

Zhang

et al. 2015

American Journal of Transplantation

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y These authors contributed equally to this study.Vascularized composite allotransplantation (VCA) has emerged as a treatment option for treating nonlife-threatening conditions. Therefore, in order to make VCA a safe reconstruction option, there is a need to minimize immunosuppression, develop tolerance-inducing strategies and elucidate the mechanisms of VCA rejection and tolerance. In this study we explored the effects of hIL-2/Fc (a long-lasting human IL-2 fusion protein), in combination with antilymphocyte serum (ALS) and short-term cyclosporine A (CsA), on graft survival, regulatory T cell (Treg) proliferation and tolerance induction in a rat hind-limb transplant model. We demonstrate that hIL-2/Fc therapy tips the immune balance, increasing Treg proliferation and suppressing effector T cells, and permits VCA tolerance as demonstrated by long-term allograft survival and donor-antigen acceptance. Moreover, we observe two distinct types of acute rejection (AR), progressive and reversible, within hIL-2/Fc plus ALS and CsA treated recipients. Our study shows differential gene expression profiles of FoxP3 versus GzmB, Prf1 or interferon-g in these two types of AR, with reversible rejection demonstrating higher Treg to Teff gene expression. This correlation of gene expression profile at the first clinical sign of AR with VCA outcomes can provide the basis for further inquiry into the mechanistic aspects of VCA rejection and future drug targets.

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“…Biopsy samples were graded according to the Banff 2007 scale. 12 Immunosuppression was adjusted on the basis of clinical judgment, biopsy results, and tacrolimus trough levels ( Table 2). Perioperative antibacterial prophylaxis consisted of vancomycin and cefazolin and was modified according to perioperative findings; Patients 2 and 3 also received perioperative antifungal prophylaxis with micafungin.…”

Section: Immunosuppressionmentioning

confidence: 99%

Three Patients with Full Facial Transplantation

et al. 2012

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The Banff 2007 Working Classification of Skin-Containing Composite Tissue Allograft Pathology

Cited by 66 publications

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Biomarker evaluation of face transplant rejection: association of donor T cells with target cell injury

Biomarker evaluation of face transplant rejection: association of donor T cells with target cell injury

Spontaneous Resolution of Acute Rejection and Tolerance Induction With IL-2 Fusion Protein in Vascularized Composite Allotransplantation

Three Patients with Full Facial Transplantation

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