title: Biomarker evaluation of face transplant rejection: association of donor T cells with target cell injury.
abstract: This series of 113 sequential biopsies of full facial transplants provides findings of potential translational significance as well as biological insights that could prompt reexamination of conventional paradigms of effector pathways in skin allograft rejection. Serial biopsies before, during, and after rejection episodes were evaluated for clinicopathological assessment that in selected cases included specific biomarkers for donor-versus-recipient T cells. Histologic evidence of rejection included lymphocyte-associated injury to epidermal rete ridges, follicular infundibula, and dermal microvessels. Surprisingly, during active rejection, immune cells spatially associated with target cell injury consisted abundantly or predominantly of lymphocytes of donor origin with an immunophenotype typical of the resident memory T-cell subset. Current dogma assumes that skin allograft rejection is mediated by recipient T cells that attack epidermal targets, and the association of donor T cells with sites of target cell injury raises questions regarding the potential complexity of immune cell interactions in the rejection process. A more histopathologically refined and immune-based biomarker approach to assessment of rejection of facial transplants is now indicated.
authors.affiliation: Division of Dermatopathology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Christine Guo
authors.initials: CG
authors.lastname: Lian
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Ericka M
authors.initials: EM
authors.lastname: Bueno
authors.affiliation: Division of Dermatopathology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Granter
authors.affiliation: Division of Dermatopathology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Alvaro C
authors.initials: AC
authors.lastname: Laga
authors.affiliation: Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Arturo P
authors.initials: AP
authors.lastname: Saavedra
authors.affiliation: Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: William M
authors.initials: WM
authors.lastname: Lin
authors.affiliation: Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Susa
authors.affiliation: Division of Dermatopathology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Qian
authors.initials: Q
authors.lastname: Zhan
authors.affiliation: Division of Renal Disease, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Anil K
authors.initials: AK
authors.lastname: Chandraker
authors.affiliation: Division of Transplant Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Stefan G
authors.initials: SG
authors.lastname: Tullius
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Bohdan
authors.initials: B
authors.lastname: Pomahac
authors.affiliation: Division of Dermatopathology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: George F
authors.initials: GF
authors.lastname: Murphy
mesh_terms: D000328:Adult; D064591:Allografts; D015415:Biomarkers / Q000032:analysis; D054445:Facial Transplantation / Q000009:adverse effects*; D005455:Fluorescent Antibody Technique; D006084:Graft Rejection / Q000276:immunology*; D006087:Graft vs Host Reaction / Q000276:immunology*; D006801:Humans; D007150:Immunohistochemistry; D008875:Middle Aged; D013601:T-Lymphocytes / Q000276:immunology*; D014019:Tissue Donors
chemical_list: D015415:Biomarkers