Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, USA; Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
J Plast Reconstr Aesthet Surg. 2023 Aug;83:155-164. doi: 10.1016/j.bjps.2023.04.050. Epub 2023 Apr 19.
The field of facial vascularized composite allotransplantation (fVCA) is still new and a limited number of patients have undergone the procedure. This has led to a lack of understanding about the impact of fVCA rejection on standard laboratory markers (e.g., CBC, BMP, CRP) for the acute management of these patients. It is not clear if rejection elicits a systemic inflammatory response that influences common inflammatory markers such as WBC and CRP. A comprehensive understanding of changes in these markers could help in the management of fVCA patients in the acute setting.
The medical records of 8 fVCA patients with a total of 9 transplants were reviewed retrospectively, and data on standard laboratory values (CBC, BMP, LFTs, CRP) and vital signs were extracted. To examine the relationship between laboratory values and rejection status, linear mixed models were used to analyze the data, taking into account their longitudinal nature (repeated measures).
A statistically significant relationship was found between the Banff grade of rejection and the relative number of basophils in the patient's blood during rejection (p = 0.005). In addition, in patients with clinical signs of rejection (e.g., facial erythema, edema) and skin biopsy showing Banff ≥ II, CRP was found to be significantly elevated (p = 0.03). The WBC count remained stable during rejection, and the relative number of neutrophils was lower at the time of rejection, indicating possible consumption at the site of rejection.
During fVCA rejection, most standard laboratory parameters and vital signs appear to be stable. However, the levels of CRP and basophils were elevated during rejection, while the neutrophil count was lower. Leukocytosis can likely be used as a marker of microbial infection in fVCA patients, as WBC does not seem to increase at the time of allograft rejection.
面部血管化复合组织同种异体移植（fVCA）领域仍处于起步阶段，接受该手术的患者数量有限。这导致人们对 fVCA 排斥反应对这些患者急性管理的标准实验室标志物（例如 CBC、BMP、CRP）的影响缺乏了解。目前尚不清楚排斥反应是否会引发全身性炎症反应，从而影响白细胞和 CRP 等常见炎症标志物。全面了解这些标志物的变化有助于在急性情况下管理 fVCA 患者。
回顾性分析了 8 例接受了总共 9 次移植的 fVCA 患者的病历，并提取了标准实验室值（CBC、BMP、LFTs、CRP）和生命体征数据。为了研究实验室值与排斥状态之间的关系，采用线性混合模型对数据进行分析，同时考虑到数据的纵向性质（重复测量）。
发现排斥的 Banff 分级与患者血液中嗜碱性粒细胞的相对数量之间存在统计学显著关系（p=0.005）。此外，在有排斥临床症状（如面部红斑、水肿）和皮肤活检显示 Banff≥II 的患者中，CRP 明显升高（p=0.03）。在排斥期间，白细胞计数保持稳定，排斥时中性粒细胞的相对数量较低，表明排斥部位可能存在消耗。
在 fVCA 排斥期间，大多数标准实验室参数和生命体征似乎稳定。然而，在排斥期间 CRP 和嗜碱性粒细胞的水平升高，而中性粒细胞计数降低。白细胞增多可能可作为 fVCA 患者微生物感染的标志物，因为白细胞计数在同种异体移植物排斥时似乎不会增加。
