دورية أكاديمية
Lymphocytic Vasculitis Associated With Mild Rejection in a Vascularized Composite Allograft Recipient: A Clinicopathological Study.
| العنوان: | Lymphocytic Vasculitis Associated With Mild Rejection in a Vascularized Composite Allograft Recipient: A Clinicopathological Study. |
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| المؤلفون: | Roy SF; Department of Pathology and Cell Biology, University of Montreal, Montreal, QC, Canada., Krishnan V; Department of Pathology and Cell Biology, University of Montreal, Montreal, QC, Canada., Trinh VQ; Department of Pathology and Cell Biology, University of Montreal, Montreal, QC, Canada.; Department of Pathology, Immunology and Microbiology, Vanderbilt University Medical Center, Nashville, TN., Collette S; Division of Nephrology, Department of Medicine, Maisonneuve-Rosemont Hospital and Department of Medicine, University of Montreal, Montreal, QC, Canada., Dufresne SF; Division of Infectious Diseases and Clinical Microbiology, Department of Medicine, Maisonneuve-Rosemont Hospital, and Department of Microbiology and Immunology, University of Montreal, Montreal, QC, Canada., Borsuk DE; Division of Plastic Surgery, Department of Surgery, Maisonneuve-Rosemont Hospital and Department of Surgery, University of Montreal, Montreal, QC, Canada., Désy D; Department of Pathology and Cell Biology, University of Montreal, Montreal, QC, Canada.; Division of Pathology, Department of Surgery, Maisonneuve-Rosemont Hospital and Department of Pathology and Cell Biology, University of Montreal, Montreal, QC, Canada. |
| المصدر: | Transplantation [Transplantation] 2020 Jul; Vol. 104 (7), pp. e208-e213. |
| نوع المنشور: | Case Reports; Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 0132144 Publication Model: Print Cited Medium: Internet ISSN: 1534-6080 (Electronic) Linking ISSN: 00411337 NLM ISO Abbreviation: Transplantation Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: Hagerstown, MD : Lippincott Williams & Wilkins Original Publication: Baltimore, Williams & Wilkins. |
| مواضيع طبية MeSH: | Facial Transplantation/*adverse effects , Graft Rejection/*diagnosis , Immunosuppressive Agents/*administration & dosage , Tacrolimus/*administration & dosage , Vasculitis/*complications, Aged ; Biopsy ; Canada ; Composite Tissue Allografts/blood supply ; Composite Tissue Allografts/pathology ; Dose-Response Relationship, Drug ; Graft Rejection/immunology ; Graft Rejection/pathology ; Graft Rejection/prevention & control ; Graft Survival/drug effects ; Graft Survival/immunology ; Humans ; Immunosuppressive Agents/pharmacokinetics ; Male ; Retrospective Studies ; Severity of Illness Index ; Skin/blood supply ; Skin/pathology ; Tacrolimus/pharmacokinetics ; Transplantation, Homologous/adverse effects ; Treatment Outcome ; Vasculitis/diagnosis ; Vasculitis/drug therapy ; Vasculitis/immunology |
| مستخلص: | Background: Histologic criteria for diagnosing acute rejection in vascularized composite tissue allograft (VCA) have been established by the Banff 2007 Working Classification of Skin-Containing Composite Tissue Allograft, but the role of early vascular lesions in graft rejection warrants additional analysis. Methods: We performed a retrospective study of 34 skin biopsies performed over 430 d for rejection surveillance, in Canada's first face allotransplant recipient. Three observers reviewed all biopsies to assess the nature and intensity of the inflammatory skin infiltrate. A complete histological and immunohistochemical review of the vascular components was performed with a focus on lymphocytic vasculitis, intravascular fibrin, vessel caliber, extent of injury, C4d positivity, and inflammatory cell phenotyping. We then correlated these data points to clinical and immunosuppression parameters. Results: Acute vascular damage in biopsies that would be classified as mild acute rejection correlates with troughs in immunosuppression and subsides when immunosuppressive tacrolimus doses are increased. Grade 0 Banff rejection and Grade I without lymphocytic vasculitis were almost indistinguishable, whereas Grade I with lymphocytic vasculitis was an easy and reproducible histologic finding. Conclusions: Our results highlight the possible relevance of vascular injury in the context of VCA, as its presence might underlie a more aggressive form of immune rejection. If these findings are validated in other VCA patients, vascular injury in mild rejection might warrant a different clinical approach. |
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| المشرفين على المادة: | 0 (Immunosuppressive Agents) WM0HAQ4WNM (Tacrolimus) |
| SCR Disease Name: | Vasculitis, Lymphocytic, Cutaneous Small Vessel |
| تواريخ الأحداث: | Date Created: 20200403 Date Completed: 20201014 Latest Revision: 20210125 |
| رمز التحديث: | 20240628 |
| DOI: | 10.1097/TP.0000000000003241 |
| PMID: | 32235257 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1534-6080 |
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| DOI: | 10.1097/TP.0000000000003241 |