Clinicopathologic features of graft rejection of the first human hand allograft.
BACKGROUND
The first human hand allograft, performed in Lyon, France, on September 23, 1998, was removed during month 29 posttransplantation as the result of rejection because the patient did not comply with the immunosuppressive treatment.


METHODS
The patient was regularly examined from the day of transplantation to amputation. Biopsies were taken from the skin of the allograft and examined immunohistologically. After amputation, various tissue specimens obtained from the allograft (including skin, tendons, bone, muscles, and joints) were studied.


RESULTS
From month 15 onward, the allografted skin presented lichenoid papules that progressively spread and coalesced into diffuse erythematous-scaly lesions over the allografted hand. Histologically, these showed an aspect of chronic lichenoid cutaneous graft-versus-host disease. At the time of amputation, erosive and necrotic areas over the skin were present. Pathologic examination of the allograft showed that the most severe changes were found in the skin. Mild inflammation was found in muscles and tendons. Bones (including bone marrow) and joints were spared.


CONCLUSIONS
The skin is the main target of rejection in human hand allografts. Close clinicopathologic monitoring of the skin is the most reliable way to detect rejection in human composite tissue allografts.
Kanitakis
Jean
J
Department of Dermatology and INSERM U346, Ed. Herriot Hospital (Pav. R), Lyon, France. kanitakis@lyon.inserm.fr.
Jullien
Denis
D
Petruzzo
Palmina
P
Hakim
Nadey
N
Claudy
Alain
A
Revillard
Jean-Pierre
JP
Owen
Earl
E
Dubernard
Jean-Michel
JM
D000328:Adult; D006084:Graft Rejection / Q000473:pathology*; D063987:Hand Transplantation; D006801:Humans; D017493:Leukocyte Common Antigens / Q000032:analysis; D008297:Male; D008875:Middle Aged; D012867:Skin / Q000276:immunology / Q000473:pathology*; D014184:Transplantation, Homologous
D017493:Leukocyte Common Antigens