title: A single center experience of abdominal wall graft rejection after combined intestinal and abdominal wall transplantation.
abstract: We report our outcomes following combined intestinal and abdominal wall transplantation, focusing on the presentation and treatment of acute rejection of the abdominal wall vascularized composite allograft (VCA). Retrospective analysis of all patients with combined intestinal/VCA transplantation was undertaken. Graft abnormalities were documented photographically and biopsies taken, with histological classification of rejection according to Banff 2007 guidelines. We have performed five combined intestinal and abdominal wall transplants to date. Two patients developed erythematous, maculopapular to papular eruptions confined to the VCA, histologically confirmed as grade II/III rejection, yet with normal bowel on endoscopy. Both patients' rashes resolved within 72 h of increasing immunosuppressive treatment. One patient later developed a recurrence of the rash, confirmed as skin rejection, but did not immediately seek medical attention. Treatment was therefore delayed, and mild intestinal rejection developed. We describe the rash associated with VCA rejection, and propose that while the skin of an abdominal wall VCA may reject independently of the intestinal allograft, delay in treatment of rejection episodes may result in rejection of the intestinal graft.
authors.affiliation: Oxford Transplant Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom. benjaminallin@doctors.org.uk
authors.forename: B S R
authors.initials: BS
authors.lastname: Allin
authors.forename: C D L
authors.initials: CD
authors.lastname: Ceresa
authors.forename: F
authors.initials: F
authors.lastname: Issa
authors.forename: G
authors.initials: G
authors.lastname: Casey
authors.forename: O
authors.initials: O
authors.lastname: Espinoza
authors.forename: S
authors.initials: S
authors.lastname: Reddy
authors.forename: S
authors.initials: S
authors.lastname: Sinha
authors.forename: H
authors.initials: H
authors.lastname: Giele
authors.forename: P
authors.initials: P
authors.lastname: Friend
authors.forename: A
authors.initials: A
authors.lastname: Vaidya
mesh_terms: D034861:Abdominal Wall / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D004890:Erythema / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis / Q000209:etiology*; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007422:Intestines / Q000473:pathology / Q000601:surgery / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D014184:Transplantation, Homologous
keywords: Abdominal wall transplantation; intestinal transplantation; rejection; vascularized composite allografts