A Single Institution’s Experience With Diagnosing Acute Cellular Rejection in Facial Allotransplantation

  • Jason S. Stratton
  • Wilma F. Bergfeld


Recent advances in immunosuppression and surgical techniques have progressed to make face transplants possible. These composite tissue grafts consist of skin, subcutaneous tissue, muscle, nerve, and bone. Accurate clinical and histologic rejection surveillance is vital to preserve the function of the graft. In December 2008, the first near-total face transplant was performed. Reviewing the pathology from this case reveals that the clinical impression and skin histology showed good correlation. However, the mucosal biopsies showed histologic signs of acute cellular rejection that far exceeded that of the skin biopsies. This discrepancy made it difficult for the pathology team to decide with certainty whether these changes truly represented acute cellular rejection.


Skin Biopsy Mucosal Biopsy Interface Inflammation Acute Cellular Rejection Cleveland Clinic Foundation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Acute cellular rejection


Cleveland Clinic Foundation




Facial allotransplantation


Hematoxylin & Eosin


Periodic Acid-Schiff Stain


Terminal deoxynucleotidyl transferase dUTP nick end labeling


  1. 1.
    Siemionow MZ, Papay F, Alam D, et al. Near-total human face transplantation for a severely disfigured patient in the USA. Lancet. 2009;374:203-209.PubMedCrossRefGoogle Scholar
  2. 2.
    Cendales LC, Kanitakis J, Schneeberger S, et al. The Banff 2007 working classification of skin-containing composite tissue allograft pathology. Am J Transplant. 2008;8:1396-1400.PubMedCrossRefGoogle Scholar
  3. 3.
    Papadimitriou JC, Cangro CB, Lustberg A, et al. Histologic features of mycophenolate mofetil-related colitis: a graft-versus-host disease-like pattern. Int J Surg Pathol. 2003;11:295-302.PubMedCrossRefGoogle Scholar
  4. 4.
    Nguyen T, Park JY, Scudiere JR, et al. Mycophenolic acid (cellcept and myofortic) induced injury of the upper GI tract. Am J Surg Pathol. 2009;33:1355-1363.PubMedCrossRefGoogle Scholar
  5. 5.
    Fricain JC, Cellerie K, Sibaud V, et al. Oral ulcers in kidney allograft recipients treated with sirolimus. Ann Dermatol Vénéréol. 2008;135:737-741.PubMedCrossRefGoogle Scholar
  6. 6.
    Kanitakis J, Badet L, Petruzzo P, et al. Clinicopathologic monitoring of the skin and oral mucosa of the first human face allograft: report on the first eight months. Transplantation. 2006;82:1610-1615.PubMedCrossRefGoogle Scholar
  7. 7.
    Swearingen B, Ravindra K, Xu H, et al. Science of composite tissue allotransplantation. Transplantation. 2008;86:627-635.PubMedCrossRefGoogle Scholar
  8. 8.
    Mathes DW, Randolph MA, Solari MG, et al. Split tolerance to a composite tissue allograft in a swine model. Transplantation. 2003;75:25-31.PubMedCrossRefGoogle Scholar
  9. 9.
    Lee WP, Yaremchuk MJ, Pan YC, et al. Relative antigenicity of components of a vascularized limb allograft. Plast Reconstr Surg. 1991;87:401-411.PubMedCrossRefGoogle Scholar
  10. 10.
    Fu BM, He XS, Yu S, et al. Tolerogenic semimature dendritic cells induce effector T-cell hyporesponsiveness by the activation of antigen-specific CD4+ CD25+ T-regulatory cells. Exp Clin Transplant. 2009;7:149-156.PubMedGoogle Scholar

Copyright information

© Springer London 2011

Authors and Affiliations

  1. 1.Department of PathologyCleveland ClinicClevelandUSA

Personalised recommendations