title: Antibody-mediated rejection in hand transplantation.
abstract: Clinical relevance of antibody-mediated rejection (ABMR) in vascularized composite allotransplantation (VCA) has not been defined. We herein describe a novel type of donor-specific antibody (DSA) and B-cell-associated rejection in hand transplantation. In 2003, a bilateral forearm transplantation was performed on a 42-year-old male patient. In 2012, the patient presented with edematous hands and forearms without skin lesions. Punch skin biopsies revealed rejection grade Banff II. Immunohistochemical analysis identified large aggregates of CD20 + lymphocytes with an architecture resembling lymph nodes. De novo DSA was found at a high level. Steroid treatment was ineffective, but administration of rituximab resulted in complete remission of clinical symptoms, evaporation of B-cell aggregates, and disappearance of DSA. We herein report the first case of what we suggest is an ABMR in VCA occurring at 9 years after forearm transplantation. Rituximab therapy successfully reversed the event.
authors.affiliation: Center for Operative Medicine, Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Annemarie
authors.initials: A
authors.lastname: Weissenbacher
authors.forename: Theresa
authors.initials: T
authors.lastname: Hautz
authors.forename: Bernhard
authors.initials: B
authors.lastname: Zelger
authors.forename: Bettina G
authors.initials: BG
authors.lastname: Zelger
authors.forename: Verena
authors.initials: V
authors.lastname: Mayr
authors.forename: Gerald
authors.initials: G
authors.lastname: Brandacher
authors.forename: Johann
authors.initials: J
authors.lastname: Pratschke
authors.forename: Stefan
authors.initials: S
authors.lastname: Schneeberger
mesh_terms: D000328:Adult; D000906:Antibodies / Q000737:chemistry*; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D018951:Antigens, CD20 / Q000378:metabolism; D001402:B-Lymphocytes / Q000276:immunology; D004487:Edema / Q000175:diagnosis; D006084:Graft Rejection / Q000188:drug therapy*; D006085:Graft Survival; D063987:Hand Transplantation / Q000379:methods*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D008214:Lymphocytes / Q000378:metabolism; D008297:Male; D000069283:Rituximab; D012867:Skin / Q000276:immunology; D014019:Tissue Donors; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D000906:Antibodies; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D007155:Immunologic Factors; D000069283:Rituximab
keywords: antibodies; outcome; rejection treatment; rituximab; vascularized composite allotransplantation