Graft vasculopathy in the skin of a human hand allograft: implications for diagnosis of rejection of vascularized composite allografts

Summary Whereas vascularized composite allografts often undergo acute rejections early in the postgraft period, rejection manifesting with severe vascular changes (graft vasculopathy) has only been observed on three occasions in humans. We report a hand‐allografted patient who developed severe rejec...

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Bibliographic Details
Published in:Transplant international 2014-11, Vol.27 (11), p.e118-e123
Main Authors: Kanitakis, Jean, Karayannopoulou, Georgia, Lanzetta, Marco, Petruzzo, Palmina
Format: Article
Language:English
Subjects:
Adult
Allografts
Amputation
Chronic Disease
chronic rejection
Graft Rejection - diagnosis
Graft Rejection - etiology
Graft Rejection - pathology
graft vasculopathy
Hand - blood supply
Hand - pathology
Hand Transplantation - adverse effects
human hand allograft
Humans
Immunosuppression
Male
Medication Adherence
Skin - blood supply
Skin - pathology
Time Factors
Transplants & implants
vascularized composite allograft
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Summary:Summary Whereas vascularized composite allografts often undergo acute rejections early in the postgraft period, rejection manifesting with severe vascular changes (graft vasculopathy) has only been observed on three occasions in humans. We report a hand‐allografted patient who developed severe rejection following discontinuation of the immunosuppressive treatment. It manifested clinically with erythematous maculopapules on the skin and pathologically with graft vasculopathy that affected both large vessels and smaller cutaneous ones. The observation that graft vasculopathy can affect skin vessels shows that it is amenable to diagnosis with usual skin biopsy as recommended for the follow‐up of these allografts. Graft vasculopathy developing in the setting of vascularized composite allografts likely represents chronic rejection due to under‐immunosuppression and, if confirmed, should be included in a future update of the Banff classification of vascularized composite allograft rejection.
ISSN:0934-0874
1432-2277
DOI:10.1111/tri.12399