Skin as a Harbinger of Rejection of Underlying Structures in Vascularized Composite Allografts: Concordance or Discordance?
1Surgery, Duke University, Durham, NC
2University of Pennsylvania, Philadelphia, PA
3University of Maryland School of Medicine, Baltimore, MD
4Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
5Pathology, Duke University, Durham, NC.
Meeting: 2016 American Transplant Congress
Abstract number: A96
Keywords: Primates, Rejection, Skin transplantation
Session Information
Session Name: Poster Session A: Clinical Vascularized Composite Allotransplantation
Session Type: Poster Session
Date: Saturday, June 11, 2016
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Halls C&D
Vascularized composite allografts (VCA) are composed of multiple tissue types. It has not been determined as to whether there is an immune hierarchy or differential susceptibility of rejection amongst the included tissues. This has implications as to the utility of skin as a diagnostic sentinel of rejection and to the design of rescue strategies for rejection or graft loss. To assess the concordance or discordance of rejection of the skin and of the underlying tissues we made use of a new multicenter collaborative initiative -VCAci. We combined the preclinical results from 3 different centers in mice and non-human primates
Methods. Samples were shared electronically by Aperio imaging and read by pathologists to assess underlying structures when the skin was rejecting graded by Banff VCA. Descriptive definitions were used for tendon,nerve,muscle,bone,artery,and vein.
Results. Pathologists reviewed 104 slides: skin (n=24),muscle (n=24),nerve (n=13),tendon (n=13),bone (n=4),artery (n=13),and vein (n=13). Banff grades showed: Grade IV (n=12), Grade III (n=5), Grade II (n=2), and Grade I (n=3), Grade 0 (n=1). When skin rejection was diagnosed,at least one other tissue in the same transplant had signs of rejection (n=22 animals). Five animals with Banff IV and four animals with Banff III showed signs of rejection in all underlying soft tissues.One animal with Grade 0 had simultaneous endothelialitis around the tendon.One animal reached endpoint from malignancy. Necropsy showed Banff II with no signs of rejection in muscle,vessels or bone.
Summary. In the majority of cases the skin acts as a harbinger of rejection in underlying structures and thus remains an accessible and reasonably sensitive method for monitoring rejection.Rescue strategies in severe cases are unlikely to allow for the preservation of underlying structures and will likely require total graftectomy.This may have implications in planning rescue strategies for complex VCA.
CITATION INFORMATION: Cendales L, Levine M, Bartlett S, Cheeseman J, Drachenberg C, Hancock W, Joshi M, Kirk A, Leoopardi F, Levin S, Uluer M, Selim A, Song M, Twaddell W, Wang L, Wang Z, Barth R. Skin as a Harbinger of Rejection of Underlying Structures in Vascularized Composite Allografts: Concordance or Discordance? Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Cendales L, Levine M, Bartlett S, Cheeseman J, Drachenberg C, Hancock W, Joshi M, Kirk A, Leoopardi F, Levin S, Uluer M, Selim A, Song M, Twaddell W, Wang L, Wang Z, Barth R. Skin as a Harbinger of Rejection of Underlying Structures in Vascularized Composite Allografts: Concordance or Discordance? [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/skin-as-a-harbinger-of-rejection-of-underlying-structures-in-vascularized-composite-allografts-concordance-or-discordance/. Accessed May 21, 2025.« Back to 2016 American Transplant Congress