Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, USA.
Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
J Plast Reconstr Aesthet Surg. 2024 Apr;91:268-275. doi: 10.1016/j.bjps.2024.02.024. Epub 2024 Feb 7.
Apart from the skin, little is known about the immunological processes in deeper tissues, which are typically not accessible to biopsy and inspection, of vascularized composite allografts (VCAs). Face transplant patients develop prominent adenopathy shortly after transplantation that resolves over time. The mechanisms underlying this process are not understood.
A retrospective cohort study was conducted on 9 patients who underwent 10 facial VCAs at the Brigham and Women's Hospital, Boston, MA, between April 2009 and July 2019. Clinical, radiological, and histological data related to lymphadenopathy of the head and neck were reviewed.
Patients who received donor-derived lymph nodes (LNs) developed bilateral lymphadenopathy of the submental or submandibular superficial LNs. Median time of presentation was POD18 (range POD6-POM3). Notably, bilateral adenopathy of the neck was not observed in later stages of follow-up (mean follow-up, 115 months). Histology of 3 LNs showed increased histiocytes and apoptosis, with the features reminiscent of necrotizing histiocytic lymphadenitis, and B and T lymphocytes (mostly CD8 + T) admixed with CD163 + histiocytes and dendritic cells. Molecular chimerism analysis in one case showed the coexistence of donor (81%) and recipient (19%) derived lymphocytes. Granzyme B (GZMB) expression confirmed the presence of increased cytotoxic T cells in this LN sample.
Our data suggested the involvement of an immunological process within the donor-derived LNs after facial allotransplantation between the recipient and donor cells. GZMB expression suggested LN rejection that can occurred independently of skin rejection. This finding supports the need to better define the role of donor-derived immune cells in the context of allograft rejection.
除皮肤外，人们对血管化复合移植物（VCAs）深层组织中的免疫过程知之甚少，这些组织通常无法进行活检和检查。面部移植患者在移植后不久会出现明显的淋巴结病，随着时间的推移会逐渐消退。其发生机制尚不清楚。
对 2009 年 4 月至 2019 年 7 月期间在马萨诸塞州波士顿市布莱根妇女医院接受 10 例面部 VCA 的 9 例患者进行了回顾性队列研究。回顾了与头颈部淋巴结病相关的临床、影像学和组织学数据。
接受供体来源淋巴结（LNs）的患者出现颏下或颌下浅部 LNs 的双侧淋巴结病。表现时间的中位数为 POD18（范围 POD6-POM3）。值得注意的是，在随访的后期阶段（平均随访 115 个月）并未观察到颈部双侧淋巴结病。3 个 LNs 的组织学显示组织细胞增多和细胞凋亡，具有坏死性组织细胞性淋巴结炎的特征，并且 B 和 T 淋巴细胞（主要是 CD8+T）与 CD163+组织细胞和树突状细胞混合。一个病例的分子嵌合分析显示供体（81%）和受体（19%）来源的淋巴细胞共存。颗粒酶 B（GZMB）表达证实了该 LN 样本中存在更多的细胞毒性 T 细胞。
我们的数据表明，在受体和供体细胞之间进行面部同种异体移植后，供体来源的 LNs 中存在免疫过程。GZMB 表达提示 LN 排斥反应可以独立于皮肤排斥反应发生。这一发现支持需要更好地定义供体来源免疫细胞在同种异体移植物排斥中的作用。
