Department of Transplantation, Hopital Edouard Herriot, Lyon, France.
Am J Transplant. 2011 Apr;11(4):808-16. doi: 10.1111/j.1600-6143.2011.03469.x.
Composite tissue allotransplantations (CTAs) have clinically shown little, if any, evidence of chronic rejection. Consequently, the effect of chronic rejection on bones, joints, nerves, muscles, tendons and vessels may still have undescribed implications. We thoroughly assessed all allograft structures by histology, magnetic resonance imaging, ultrasonography and high resolution peripheral quantitative computed tomography scan in four bilateral hand-grafted patients (10, 7, 3 and 2 years of follow-up, respectively) and in one facial allotransplantation (5 years of follow-up). All the recipients presented normal skin structure without dermal fibrosis. Vessels were patent, without thrombosis, stenosis or intimal hyperplasia. Tendons and nerves were also normal; muscles showed some changes, such as a variable degree of muscular hypotrophy, particularly of intrinsic muscles, accompanied by fatty degeneration that might be related to denervation. In the majority of hand-grafted patients graft radius and recipient tibia showed a decrease in trabecular density, although in the graft radius the alterations also involved the cortices. No deterioration of graft function was noted. In these cases of CTA no signs of chronic graft rejection have been detected. However, the possibility that chronic rejection may develop in CTA exists, highlighting the necessity of close continuous follow-up of the patients.
复合组织同种异体移植（CTA）在临床上几乎没有表现出慢性排斥反应的迹象。因此，慢性排斥反应对骨骼、关节、神经、肌肉、肌腱和血管的影响可能仍有未被描述的影响。我们通过组织学、磁共振成像、超声检查和高分辨率外周定量计算机断层扫描对 4 例双侧手部同种异体移植患者（分别为 10、7、3 和 2 年随访）和 1 例面部同种异体移植患者（5 年随访）的所有同种异体移植物结构进行了彻底评估。所有受者均表现出正常的皮肤结构，无皮肤纤维化。血管通畅，无血栓、狭窄或内膜增生。肌腱和神经也正常；肌肉有一些变化，如不同程度的肌肉萎缩，特别是内在肌肉，伴有脂肪变性，可能与去神经有关。在大多数手部同种异体移植患者中，移植物桡骨和受者胫骨的骨小梁密度降低，尽管在移植物桡骨中，这些改变也涉及皮质。未发现移植物功能恶化。在这些 CTA 病例中，未发现慢性移植物排斥反应的迹象。然而，CTA 中可能会发生慢性排斥反应，这突出了对患者进行密切持续随访的必要性。
