Article
Pleomorphic Clinical Presentation of Acute Rejection in Face Transplantation
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Published: | September 28, 2015 |
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Introduction: Face transplantation aims to restore severely disfigured patients in a one-step procedure. The most common complication after face transplantation is acute rejection, and it is even more common than in solid organ transplantation. The skin on the facial allograft is evaluated to diagnose and therefore treat acute cellular rejection rapidly. However, rejection can present in more than one fashion and this complicates differentiation of rejection from other mostly dermatitic skin conditions. This challenge is particularly evident in hospitals with limited experience in the diagnosis of acute rejection of facial allografts.
Methods: We analyzed our experience with acute rejection episodes in seven face transplant recipients (6 months – 6 years post op). All acute rejection episodes that displayed Banff grade II rejection or higher after histopathological evaluation were taken into account.
Results: We found pleomorphic clinical presentation of acute rejection in our patients. During acute rejection episodes in the early post-transplant period, all patients displayed pronounced erythema and some edema. Over a longer follow up (>4 years, n=4), however, we observed acute rejection episodes associated with less erythema and no edema. There was one episode of late grade III acute rejection with erythema mostly present at the suture lines.
Discussion: We demonstrate a transition in presentation of acute rejection from strong erythematous efflorescences towards mostly more discrete changes with time after facial transplantation. It remains to be elucidated whether different expression patterns of acute rejection are associated with different responses to standard rescue therapies.