title: Reflectance confocal microscopy as a useful diagnostic tool for monitoring of skin containing vascularized composite allograft rejection: A preliminary study on rats.
abstract: Vascularized composite allografts can undergo immune-mediated rejection, and skin biopsies are needed for monitoring of the transplant. However it is an invasive method, and requires processing time and pathological assessment. The purpose of this study is to use a new noninvasive monitoring method of the reflectance confocal microscopy (RCM) to determine severity of the allograft rejection on rats. Five groin flap allotransplantation were performed between 10 male Sprague-Dawley rats. Immunosuppressive therapy with cyclosporine A was given to the recipients during 10 days after surgery and was ended at the 10th postoperative days to allow acute transplant rejection. Following cessation of CsA, concomitant RCM evaluation and skin biopsy was performed every other day from each animal until total rejection of the allograft. Complete rejection of the allograft took nearly about 10 days and 4 or 5 RCM evaluation and skin biopsy was performed from each rat during this period. A total of 17 specimens were evaluated. A scoring system was developed based on the RCM findings. Skin biopsies were evaluated according to the Banff 2007 working classification criteria. RCM evaluation revealed epidermal irregularity and collagen destruction, however mild perivascular inflammation and degeneration of the basal epidermal layer were observed in early and late rejection period respectively with histopathologic evaluation. High correlation was found between the RCM scores and histopathologic grading. The RCM may be the useful tool to reduce the need for skin biopsy for monitoring of the skin containing vascularized composite allograft.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Zor
authors.affiliation: Gulhane Military Medical Academy, Haydarpasa Training Hospital, Department of Plastic and Reconstructive Surgery, Istanbul, Turkey.|Department of Orthopaedic Surgery, University of Illinois, College of Medicine, Chicago, IL.
authors.forename: Huseyin
authors.initials: H
authors.lastname: Karagoz
authors.affiliation: Department of Dermatology, Istanbul Training and Research Hospital, Istanbul, Turkey.
authors.forename: Asli Turgut
authors.initials: AT
authors.lastname: Erdemir
authors.affiliation: Department of Pathology, Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: Yildirim
authors.initials: Y
authors.lastname: Karslioglu
authors.affiliation: Department of Biostatistics and FAVOR Laboratories, Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: Cengiz Han
authors.initials: CH
authors.lastname: Acikel
authors.affiliation: Department of Plastic and Reconstructive Surgery, Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: Rezarta
authors.initials: R
authors.lastname: Kapaj
authors.affiliation: Department of Plastic and Reconstructive Surgery, Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: Serbulent
authors.initials: S
authors.lastname: Guzey
authors.affiliation: Department of Dermatology, Istanbul Training and Research Hospital, Istanbul, Turkey.
authors.forename: Mehmet Salih
authors.initials: MS
authors.lastname: Gurel
authors.affiliation: Department of Plastic and Reconstructive Surgery, Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: Selcuk
authors.initials: S
authors.lastname: Isik
authors.affiliation: Department of Orthopaedic Surgery, University of Illinois, College of Medicine, Chicago, IL.
authors.forename: Maria
authors.initials: M
authors.lastname: Siemionow
mesh_terms: D000359:Aftercare / Q000379:methods; D000818:Animals; D001706:Biopsy; D064595:Composite Tissue Allografts / Q000000981:diagnostic imaging* / Q000473:pathology; D006084:Graft Rejection / Q000000981:diagnostic imaging* / Q000473:pathology; D006119:Groin; D008297:Male; D018613:Microscopy, Confocal; D061848:Optical Imaging / Q000379:methods*; D051381:Rats; D017207:Rats, Sprague-Dawley; D012867:Skin / Q000000981:diagnostic imaging* / Q000473:pathology