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Monitoring Rejection with a Distant Sentinel Skin Graft

  • Marco Lanzetta
  • Luca Rovati

Abstract

While an internal organ is hidden but works immediately after the transplantation, a hand is fully visible and takes many months to gradually recover sensation and movement [1, 2]. Assessment of viability of transplanted internal organs is usually done by measuring function, either by biochemical evaluations or routine biopsies [3, 4]. In case of a hand, monitoring is largely based on visual inspection [5, 6, 7]. This is a definite advantage compared with internal organs, where an initial rejection may go undetected for some time until the next scheduled biochemical tests or biopsy are carried out. Methods for monitoring rejection in human hand transplantation include visual inspection of skin changes and histological analysis of biopsies. However, repetitive skin biopsies on a relatively small area may pose the problem of leaving multiple visible scars, especially if these procedures must be carried out over a period of many years.

Keywords

Human Hand Skin Allograft Mixed Leukocyte Reaction Skin Component Hand Transplantation 
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.

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References

  1. 1.
    Llull R (1998) An open proposal for clinical composite tissue transplantation. Transplant Proc 30:2692–2696PubMedCrossRefGoogle Scholar
  2. 2.
    Dubernard JM, Owen ER et al (2000) First human hand transplantation. Case report. Transpl Int 13[Suppl]: 521–524CrossRefGoogle Scholar
  3. 3.
    Russo FP, Bassanello M, Senzolo M et al (2001) Functional and morphological graft monitoring after liver transplantation. Clin Chim Acta 310:17–23PubMedCrossRefGoogle Scholar
  4. 4.
    VanBuskirk AM, Pidwell DJ, Adams PW, Orosz CG (1997) Transplantation immunology. JAMA 278:1993–1999PubMedCrossRefGoogle Scholar
  5. 5.
    Dubernard JM, Owen ER, Lanzetta M, Hakim N (2000) What is happening with hand transplants? Lancet 1357:1711–1712Google Scholar
  6. 6.
    Dubernard JM, Owen ER, Herzberg G et al (1999) Human hand allograft: report on first 6 months. Lancet 353:1315–1320PubMedCrossRefGoogle Scholar
  7. 7.
    Jones JW, Gruber SA, Barker JH, Breidenbach WC (2000) Successful hand transplantation. One-year follow-up. N Engl J Med 343:468–473PubMedCrossRefGoogle Scholar
  8. 8.
    Buttemeyer R, Jones NF, Min Z, Rao U (1996) Rejection of the component tissues of limb allografts in rats immunosuppressed with FK-506 and cyclosporine. Plast Reconstr Surg 97:139–148PubMedCrossRefGoogle Scholar
  9. 9.
    Lanzetta M, Nolli R, Borgonovo A et al (2001) Hand transplantation: Immunosuppression, ethics and indications. J Hand Surg [Br] 26:511–516Google Scholar
  10. 10.
    Steinman RM, Witmer MD (1978) Lymphoid dendritic cells are potent stimulators of the primary mixed leukocyte reaction in mice. Proc Natl Acad Sci USA 75:5132–5136PubMedCrossRefGoogle Scholar
  11. 11.
    Stark GB, Swartz WM, Narayanan K, Moller AR (1987) Hand transplantation in baboons. Transpl Proc 19:3968–3971Google Scholar
  12. 12.
    Sakai A, Yakushiji K, Mashimo S (1980) Lymphocyte stimulation by allogeneic tissue cells in rats: with special reference to differential survival of skin and kidney allografts. Transplant Proc 12:74–81PubMedGoogle Scholar
  13. 13.
    Lee WP, Yaremchuk MJ, Pan YC et al (1991) Relative antigenicity of components of a vascularized limb allograft. Plast Reconstr Surg 87:401–411PubMedCrossRefGoogle Scholar
  14. 14.
    Lanzetta M, Ayrout C, Gal A et al (2003) Experimental limb transplantation. Part II: excellent return of function and indefinite survival after immunosuppression withdrawal. Transplantation 76:1548–1555CrossRefGoogle Scholar
  15. 15.
    Doi K (1979) Homotransplantation of limbs in rats. A preliminary report on an experimental study with nonspecific immunosuppressive drugs. Plast Reconstr Surg 64:613–621PubMedCrossRefGoogle Scholar
  16. 16.
    Rosenberg AS, Singer A (1992) Cellular basis of skin allograft rejection: an in vivo model of immune-mediated tissue destruction. Annu Rev Immunol 10:333–358PubMedGoogle Scholar
  17. 17.
    Kanitakis J, Jullien D, Nicolas JF et al (2000) Sequential histological and immunohistochemical study of the skin of the first human hand allograft. Transplantation 69:1380–1385PubMedCrossRefGoogle Scholar
  18. 18.
    Kanitakis J, Jullien D, Petruzzo P et al (2003) Clinicopathologic features of graft rejection of the first human hand allograft. Transplantation 76:688–693PubMedCrossRefGoogle Scholar
  19. 19.
    Kanitakis J, Jullien D, Petruzzo P et al (2001) Immunohistologic studies of the skin of human hand allografts: our experience with two patients. Transplant Proc 33:1722PubMedCrossRefGoogle Scholar
  20. 20.
    Kanitakis J, Petruzzo P, Jullien D et al (2005) Pathological score for the evaluation of allograft rejection in human hand (composite tissue) allotransplantation. Eur J Dermatol 15:235PubMedGoogle Scholar
  21. 21.
    Hovius SER, van Adrichem LN, van der Heijden PM et al (1988) Postoperative monitoring of allogeneic limb transplantation in rats. Ann Plast Surg 21:559–565PubMedCrossRefGoogle Scholar
  22. 22.
    Black KS, Hewitt CW, Howard EB et al (1983) Diagnosis of rejection and functional analysis of composite tissue (CT) and skin allografts prolonged with cyclosporine. Transpl Proc 15:3069–3072Google Scholar
  23. 23.
    Petruzzo P, Revillard JP, Kanitakis J et al (2003) First human double hand transplantation: efficacy of a conventional immunosuppressive protocol. Clin Transplant 17:455–460PubMedCrossRefGoogle Scholar
  24. 24.
    Diefenbeck M (2006) Knee and femur transplantations. Acts from the 6th International Symposium on CTA Tucson, ArizonaGoogle Scholar

Copyright information

© Springer-Verlag Italia 2007

Authors and Affiliations

  • Marco Lanzetta
    • 1
    • 2
    • 3
    • 4
    • 5
  • Luca Rovati
    • 6
  1. 1.Italian Institute of Hand SurgeryMonza,MilanItaly
  2. 2.Hand Surgery and Reconstructive Microsurgery UnitSan Gerardo HospitalMonza,MilanItaly
  3. 3.University of Milan-BicoccaMilanItaly
  4. 4.University of CanberraAustralia
  5. 5.International Hand and CompositeTissue Allograft SocietyAustralia
  6. 6.Plastic Surgery UnitSan Gerardo HospitalMonza, MilanItaly

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