OBJECTIVE: Vascularized composite allograft (VCA) transplantation has become a feasible reconstructive option for patients with severe facial disfigurement. Short term patient and graft survival have been excellent. The most frequent comorbidity is acute rejection, and almost all recipients experience at least one acute rejection episode in the first post-transplant year.

METHODS: We utilized a novel induction immunosuppression regimen in face VCA, targeting both T and B lymphocyte depletion and maintenance immunosuppression triple therapy in a 41 year old caucasian male firefighter who in 2001 sustained a total facial burn injury with numerous sensitizing events. The donor was ABO identical, and crossmatch was negative CDC XM and T FCXM, and repeatedly + B FCXM. Induction included anti-thymocyte globulin (6mg/kg) and rituximab 1000mg.

RESULTS: There have been no episodes of clinically evident acute rejection in the first 2 years post transplant. The recipient has not developed de novo DSA. There have been no infectious complications or medical comorbidities to date. Graft biopsies have not shown Banff rejection. C4d staining has been present without clinical evidence of rejection or graft dysfunction.

CONCLUSIONS: Acute rejection remains a major morbidity in face VCA transplantation. Induction immunosuppression targeting both T and B lymphocyte depletion combined with standard triple therapy maintenance immunosuppression may show promise in reducing the rate of acute rejection episodes.

CITATION INFORMATION: Gelb B., Diaz-Siso J., Plana N., Jacoby A., Rifkin W., Khouri K., Ceradini D., Rodriguez E. Absence of Rejection in a Facial Allograft Recipient with a Postive Flow Crossmatch 24 Months after Induction with Rabbit Anti-Thymocyte Globulin and Anti-CD20+ Monoclonal Antibody Am J Transplant. 2017;17 (suppl 3).

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