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Classification of Face Rejection: Banff classification for CTA

  • Jean Kanitakis
  • Linda C. Cendales
Chapter

Abstract

Facial allotransplantation (FA) has recently emerged as a new viable option for reconstruction of severe facial tissue defects that are not amenable to conventional reconstructive techniques. FA falls within the spectrum of Composite Tissue Allografts (CTA), and as such may undergo allograft rejection. The experience obtained so far from the limited number of FA shows that the recipients develop, in the first post-graft months, signs of (skin) rejection that can be reversed with adjustment of the immunosuppressive treatment. The severity of skin rejection can be assessed with a pathological score that was proposed during the 2007 Banff meeting in La Coruna, Spain (Banff CTA-07) and classifies rejection in five grades (0–IV) according to the severity of pathological changes in the skin. There are still several questions that remain so far unanswered regarding rejection in FA, including namely the role of skin-infiltrating cells and the possibility of development of chronic rejection.

Keywords

Acute Rejection Oral Mucosa Allograft Rejection Allergic Contact Dermatitis Chronic Rejection 
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.

Abbreviations

AMR

Antibody-mediated rejection

CTA

Composite tissue allografts

FA

Facial allotransplantation

GVHD

Graft versus host disease

HES

Hematoxylin-eosin-saffron

PAS

Periodic Acid Schiff stain

References

  1. 1.
    Devauchelle B, Badet L, Lengelé B, et al. First human face allograft: early report. Lancet. 2006;368:203-209.PubMedCrossRefGoogle Scholar
  2. 2.
    Dubernard J, Lengelé B, Morelon E, et al. Outcomes 18 months after the first human partial face transplantation. N Engl J Med. 2007;357:2451-2460.PubMedCrossRefGoogle Scholar
  3. 3.
    Guo S, Han Y, Zhang X, et al. Human facial allotransplantation: a 2-year follow-up study. Lancet. 2008;372:631-638.PubMedCrossRefGoogle Scholar
  4. 4.
    Gordon CR, Siemionow M, Papay F, et al. The world’s experience with facial transplantation: what have we learned thus far? Ann Plast Surg. 2009;63:572-578.PubMedCrossRefGoogle Scholar
  5. 5.
    Eaton L. Spanish doctors carry out first transplantation of a full face. BMJ. 2010;340:c2303.PubMedCrossRefGoogle Scholar
  6. 6.
    Lantieri L, Meningaud JP, Grimbert P, et al. Repair of the lower and middle parts of the face by composite tissue allotransplantation in a patient with massive plexiform neurofibroma: a 1-year follow-up study. Lancet. 2008;372:639-645.PubMedCrossRefGoogle Scholar
  7. 7.
    Pomahac B, Pribaz J, Eriksson E, et al. Restoration of facial form and function after severe disfigurement from burn injury by a composite facial allograft. Am J Transplant. 2011. doi: 10.1111/j.1600-6143.2010.03368.x. [Epub ahead of print]PubMedCrossRefGoogle Scholar
  8. 8.
    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
  9. 9.
    Morelon E, Testelin S, Petruzzo P, et al. New partial face allograft transplantation: report on first three months. Presented at: the XXIIIth International Congress of the Transplantation Society; August 15–19, 2010; Vancouver, British Columbia, Canada.Google Scholar
  10. 10.
    Strong C. An ongoing issue concerning facial transplantation. Am J Transplant. 2010;10:1115-1116.PubMedCrossRefGoogle Scholar
  11. 11.
    Siemionow M, Gordon C. Overview of guidelines for establishing a face transplant program: a work in progress. Am J Transplant. 2010;10:1290-1296.PubMedCrossRefGoogle Scholar
  12. 12.
    Kanitakis J, Jullien D, Petruzzo P, et al. Clinicopathologic features of graft rejection of the first human hand allograft. Transplantation. 2003;76:688-693.PubMedCrossRefGoogle Scholar
  13. 13.
    Schneeberger S, Gorantla V, van Riet R, et al. Atypical acute rejection after hand transplantation. Am J Transplant. 2008;8:688-696.PubMedCrossRefGoogle Scholar
  14. 14.
    Cendales L, Breidenbach W. Hand transplantation. Hand Clin. 2001;17:449-510.Google Scholar
  15. 15.
    Kanitakis J, Badet L, Petruzzo P, et al. Clinicopathological 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
  16. 16.
    Bejarano PA, Levi D, Nassiri M, et al. The pathology of full-thickness cadaver skin transplant for large abdominal defects. Am J Surg Pathol. 2004;28:670-675.PubMedGoogle Scholar
  17. 17.
    Schneeberger S, Kreczy A, Brandacher G, Steurer W, Margreiter R. Steroid- and ATG-resistant rejection after double forearm transplantation responds to Campath-1H. Am J Transplant. 2004;4:1372-1374.PubMedCrossRefGoogle Scholar
  18. 18.
    Kanitakis J, Petruzzo P, Jullien D, et al. Pathological score for the evaluation of allograft rejection in human hand (composite tissue) allotransplantation. Eur J Dermatol. 2005;15:235-238.PubMedGoogle Scholar
  19. 19.
    Cendales L, Kirk A, Moresi M, et al. Composite tissue allotransplantation: classification of clinical acute skin rejection. Transplantation. 2006;81:418-422.PubMedCrossRefGoogle Scholar
  20. 20.
    Cendales L, 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
  21. 21.
    Lee W, Yaremchuk M, Pan Y, Randolph MA, Tan CM, Weiland AJ. Relative antigenicity of components of a vascularized limb allograft. Plast Reconstr Surg. 1991;87:401-411.PubMedCrossRefGoogle Scholar
  22. 22.
    Hautz T, Zelger B, Grahammer J, et al. Molecular markers and targeted therapy of skin rejection in composite tissue allotransplantation. Am J Transplant. 2010;10:1200-1209.PubMedCrossRefGoogle Scholar
  23. 23.
    Landin L, Cavadas P, Ibanez I, et al. CD3+ mediated rejection and C4d deposition in two composite tissue (bilateral hand) allograft recipients after induction with alemtuzumab. Transplantation. 2009;87:776-781.PubMedCrossRefGoogle Scholar
  24. 24.
    Kanitakis J, McGregor B, Badet L, et al. Absence of C4d deposition in human composite tissue (hands and face) allograft biopsies: an immunoperoxidase study. Transplantation. 2007;84:265-267.PubMedCrossRefGoogle Scholar
  25. 25.
    Kanitakis J. The challenge of dermatopathological diagnosis of rejection of composite tissue allografts: a review. J Cutan Pathol. 2008;35:738-744.PubMedCrossRefGoogle Scholar
  26. 26.
    Breidenbach W, Ravindra K, Blair B, Burns C, et al. Transplant arteriopathy in clinical hand transplantation. Presented at: the 9th Meeting of the International Society of Hand and Composite Tissue Allotransplantation; September 11–12, 2009; Valencia, Spain.Google Scholar

Copyright information

© Springer London 2011

Authors and Affiliations

  1. 1.Department of Dermatology/Laboratory of DermatopathologyEdouard Herriot Hospital GroupLyonFrance

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