title: Graft vasculopathy in the skin of a human hand allograft: implications for diagnosis of rejection of vascularized composite allografts.
abstract: Whereas vascularized composite allografts often undergo acute rejections early in the postgraft period, rejection manifesting with severe vascular changes (graft vasculopathy) has only been observed on three occasions in humans. We report a hand-allografted patient who developed severe rejection following discontinuation of the immunosuppressive treatment. It manifested clinically with erythematous maculopapules on the skin and pathologically with graft vasculopathy that affected both large vessels and smaller cutaneous ones. The observation that graft vasculopathy can affect skin vessels shows that it is amenable to diagnosis with usual skin biopsy as recommended for the follow-up of these allografts. Graft vasculopathy developing in the setting of vascularized composite allografts likely represents chronic rejection due to under-immunosuppression and, if confirmed, should be included in a future update of the Banff classification of vascularized composite allograft rejection.
authors.affiliation: Department of Dermatology, Edouard Herriot Hospital Group, Lyon, France; Department of Pathology, Edouard Herriot Hospital Group, Lyon, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Kanitakis
authors.forename: Georgia
authors.initials: G
authors.lastname: Karayannopoulou
authors.forename: Marco
authors.initials: M
authors.lastname: Lanzetta
authors.forename: Palmina
authors.initials: P
authors.lastname: Petruzzo
mesh_terms: D000328:Adult; D064591:Allografts; D000671:Amputation, Surgical; D002908:Chronic Disease; D006084:Graft Rejection / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D006225:Hand / Q000098:blood supply / Q000473:pathology; D063987:Hand Transplantation / Q000009:adverse effects*; D006801:Humans; D007165:Immunosuppression Therapy; D008297:Male; D055118:Medication Adherence; D012867:Skin / Q000098:blood supply / Q000473:pathology; D013997:Time Factors
keywords: chronic rejection; graft vasculopathy; human hand allograft; vascularized composite allograft