Clinicopathologic monitoring of the skin and oral mucosa of the first human face allograft: Report on the first eight months.
BACKGROUND
The first human face allograft was performed in France on November 27, 2005. We report herein the clinicopathologic findings from the skin and oral mucosa of this allograft during the first eight months.


METHODS
Sequential biopsies were taken from the facial skin (n = 3), oral mucosa (n = 20), and sentinel skin graft (n = 11) from day 3 to day 220 postgraft and examined (immuno)histologically, using a pathological score previously proposed for evaluation of rejection in composite tissue (hand) transplantation.


RESULTS
The patient developed clinically rejection episodes at day 20 and during the eighth month postgraft, manifesting with redness and edema of the facial skin, oral mucosa, and sentinel graft skin. Pathologically, changes suggestive of rejection grades 0, I, II, and III were seen in 1, 1, 1, and 0 biopsies of facial skin, 7, 2, 1, and 1 biopsies of sentinel skin graft and 3, 5, 8, and 4 biopsies of oral mucosa, respectively. Pathological changes were generally more severe in the oral mucosa than in facial and sentinel graft skin (mean scores 1.85, 0.64, and 1, respectively).


CONCLUSIONS
As it happens with other composite tissue allografts, close clinicopathologic monitoring of the skin (and oral mucosa) seems to be the most reliable way to detect rejection in the setting of human facial tissue allotransplantation. Apart from these rejection episodes, the skin and mucosa maintained a normal microscopic structure, paralleling functional recovery.
Kanitakis
Jean
J
Department of Dermatology, Ed. Herriot Hospital, Lyon, France. kanitakis@lyon.inserm.fr
Badet
Lionel
L
Petruzzo
Palmina
P
Béziat
Jean Luc
JL
Morelon
Emmanuel
E
Lefrançois
Nicole
N
Françès
Camille
C
Claudy
Alain
A
Martin
Xavier
X
Lengelé
Benoit
B
Testelin
Sylvie
S
Devauchelle
Bernard
B
Dubernard
Jean Michel
JM
D000328:Adult; D001733:Bites and Stings / Q000473:pathology* / Q000601:surgery; D005145:Face / Q000473:pathology*; D005151:Facial Injuries / Q000473:pathology* / Q000601:surgery; D005260:Female; D006084:Graft Rejection / Q000473:pathology*; D006085:Graft Survival; D006801:Humans; D008991:Monitoring, Physiologic; D009061:Mouth Mucosa / Q000473:pathology*; D012867:Skin / Q000473:pathology*; D016038:Skin Transplantation; D014019:Tissue Donors; D014184:Transplantation, Homologous