First Complete Full-Face Allograft Transplantation. Clinicopathologic Features of Graft Rejection
Jose J Torres, Berta Ferrer, Joan-Pere Barret, Javier Bueno, Cleofe Romagosa, Santiago Ramon y Cajal, Pere Huguet. Vall d'Hebron Universitary Hospital, Barcelona, Catalonia, Spain
Background: The first human full face allograft was performed in Spain on March 27, 2010. The recipient was a 30 year old male with an accidental gunshot to face in 2005. We report the pathological findings from the skin and oral mucosa of this allograft during the the following 15 months after surgery.
Design: A total of 38 biopsies of skin (20) and mucosa (18) grafts were taken from 4 to 472 day post-grafting. All biopsies were analyzed, including those made by clinical suspicion of acute rejection (redness and edema of facial skin and oral mucosa) and control ones. All samples were examined following the criteria of Banff-Working system of classification of Skin-Containing Composite Tissue Allograft (CTA) proposed in 2008.
Results: Regarding the clinical evaluation, biopsies taken without clinical suspicious of rejection (control samples) (19) showed none rejection in 6 of 19 samples, mild rejection in 10 of 19 samples and moderate rejection in 3 of 19 samples. Skin control samples showed rejection changes more frequently than mucosa samples (7/10 vs 3/9). In contrast, when samples were taken due a clinical suspicion of acute rejection, histologically correspond to moderate grade (Grade II) in 12 of 19 cases, and severe rejection in 5 of 19 cases in both skin and mucosa samples. One clinical episode iniciated on day 87 post trasplant showed a discorrelation between skin and mucosa with a grade II rejection in the skin and grade I in the mucosa. Grade IV was not observed in any case.
Conclusions: Histopathological monitoring of full-face allograft trasplantation is mandatory to detect and grade acute rejection episodes with or without a clinical suspicious. The importance of histological grade I rejection without clinical manifestations remains unclear. Skin and mucosal biopsies showed a close correlation in histological assessment of acute rejection.
Wednesday, March 21, 2012 1:00 PM
Poster Session VI # 130, Wednesday Afternoon