Department of Plastic and Reconstructive Surgery, Cleveland Clinic, 9500 Euclid Ave, 44195 Cleveland, OH, USA.
Department of Pathology, Cleveland Clinic, 9500 Euclid Ave, 44195 Cleveland, OH, USA.
J Plast Reconstr Aesthet Surg. 2019 Jan;72(1):23-34. doi: 10.1016/j.bjps.2018.05.018. Epub 2018 Jun 9.
We present a case of skin allograft survival in a patient who previously received a bone marrow transplant from the same HLA-matched donor. DNA fingerprinting of skin biopsies showed mixed cellularity originating from the donor and recipient (68% and 32% donor DNA in the allograft skin and the native recipient's skin, respectively). Histologic sections demonstrated both grade 3/4 rejection and graft-versus-host-disease. We have conducted a systematic review in search for other cases of donor skin allograft survival after a bone marrow or hematopoietic stem cell transplantation.
All reported cases in English, Spanish, French, and German were captured using the electronic databases. Bibliographies of relevant articles were manually searched.
Nineteen patients (12 females) who received skin allografts from their bone marrow or hematopoietic stem cell donors were identified. Average age was 27.2 years (range: 5 months to 64 years). Skin allografts were used to treat graft-versus-host-disease, Herlitz junctional epidermolysis bullosa, and to test tolerance before a kidney transplantation from the same donor. Eight cases were not receiving immunosuppressive therapy. Allografts survived in all patients. In three patients, skin punch biopsies were taken, and these biopsies demonstrated mixed donor and recipient cellularity. The pathology result is specified in two more cases, with no signs of rejection.
The same donor skin allografts may be a safe option to treat severe cutaneous conditions in recipients of a bone marrow/hematopoietic stem cell transplantation. However, future studies are needed to confirm these results.
我们报告了一例患者在接受来自同一 HLA 匹配供体的骨髓移植后皮肤移植物存活的病例。皮肤活检的 DNA 指纹分析显示，移植物和受者的细胞混合性起源（供体和异体移植物皮肤中的供体 DNA 分别为 68%和 32%，受者的原生皮肤为 100%）。组织学切片显示 3/4 级排斥反应和移植物抗宿主病。我们进行了系统评价，以寻找其他骨髓或造血干细胞移植后供体皮肤移植物存活的病例。
使用电子数据库捕获所有用英文、西班牙语、法语和德语报告的病例。手动搜索相关文章的参考文献。
确定了 19 名（12 名女性）患者接受了来自骨髓或造血干细胞供体的皮肤移植物。平均年龄为 27.2 岁（范围：5 个月至 64 岁）。皮肤移植物用于治疗移植物抗宿主病、赫利茨交界性表皮松解症，并在同一供体的肾脏移植前进行耐受测试。8 例未接受免疫抑制治疗。所有患者的移植物均存活。在 3 例患者中进行了皮肤打孔活检，这些活检显示供体和受者的细胞混合性。另外 2 例病例的病理结果表明没有排斥迹象。
对于骨髓/造血干细胞移植受者严重皮肤疾病，同种异体皮肤移植物可能是一种安全的选择。然而，需要进一步的研究来证实这些结果。
