Department of Dermatology and Pathology, Cleveland Clinic, Cleveland, OH.
Am J Transplant. 2013 Oct;13(10):2750-64. doi: 10.1111/ajt.12379. Epub 2013 Aug 6.
In December of 2008, our institution performed a near total face transplant. The patient was monitored for signs of rejection assessed by paired skin and mucosa biopsies. The results of histological review of 120 biopsies collected during the first 4 years posttransplant are discussed. All biopsies were stained with hematoxylin and eosin, periodic acid-Schiff, immunohistochemical and TUNEL assays and graded using the Banff 2007 classification. Grade III rejection was diagnosed clinically at weeks 45 and 66, posttransplant; week 45 was determined as folliculitis while the erythema episode at week 66 confirmed an acute rejection (AR) that required hospitalization. The mucosa frequently showed interface inflammation without clinical signs of rejection and was not present in skin biopsies. In all, 34 of the 45 mucosal biopsies (75%) showed these interface changes. Clinical symptoms concurred with skin pathology in two grade III rejections. The mucosa showed histologic signs of rejection more frequently, which may indicate: increased mucosal sensitivity to rejection, a different type or subtype of AR that is specific to the mucosa, or a nonspecific process such as a drug effect. With more data and world experience, the diagnosis of face transplant rejection will be better defined and the Banff classification enhanced.
2008 年 12 月，我院进行了一次近乎全脸面移植。通过配对皮肤和黏膜活检评估排斥迹象来监测患者。讨论了在移植后 4 年内收集的 120 次活检的组织学回顾结果。所有活检均用苏木精和伊红、过碘酸希夫、免疫组织化学和 TUNEL 检测染色，并使用 2007 年 Banff 分类进行分级。移植后第 45 和 66 周临床诊断为 3 级排斥；第 45 周被确定为滤泡炎，而第 66 周的红斑期证实了需要住院治疗的急性排斥（AR）。黏膜经常表现出无临床排斥迹象的界面炎症，而皮肤活检中没有发现。总共 45 次黏膜活检中有 34 次（75%）显示出这些界面变化。两次 3 级排斥的临床症状与皮肤病理学相符。黏膜显示出排斥的组织学迹象更为频繁，这可能表明：对排斥的黏膜敏感性增加、对黏膜有特异性的不同类型或亚型的 AR，或非特异性过程，如药物作用。随着更多的数据和世界经验，对面部移植排斥的诊断将得到更好的定义，并增强 Banff 分类。
