title: Defining the Role of Skin and Mucosal Biopsy in Facial Allotransplantation: A 2-Year Review and Analysis of Histology.
abstract: BACKGROUND
  The implications of allograft skin and mucosal biopsy findings on classification of rejection and treatment remain unclear.
  
  
  METHODS
  Following facial allotransplantation, scheduled surveillance allograft skin and mucosal biopsy specimens were obtained. Clinical concern for acute rejection prompted biopsies off schedule. Compilation of biopsy results, Banff grading, immunosuppression, and clinical correlation were critically reviewed for a 2-year follow-up.
  
  
  RESULTS
  A total of 39 biopsy specimens at 21 time points were obtained for analysis, including allograft skin (n = 21), mucosa (n = 17), and a lesion (n = 1). The patient had three episodes of acute rejection warranting treatment. Discordance between skin and mucosa occurred in 55.6 percent of biopsy specimens (p = 0.01). Mucosa concordance with the clinical evaluation occurred in 38.9 percent of biopsy specimens (p = 0.02), and skin concordance with clinical evaluation was present in 81 percent of biopsy specimens (p = 0.01).
  
  
  CONCLUSIONS
  The clinical utility of mucosal biopsy remains elusive. The authors' experience suggests that mucosal or skin biopsy, alone, should not drive the decision-making process in treatment. Skin biopsies are more likely to confirm clinical suspicion of rejection than mucosal histology. Data from other institutions are lacking, and future reporting may help elucidate the role of mucosal and skin biopsy in facial allotransplantation.
  
  
  METHODS
  Diagnostic, V.
authors.affiliation: New York, N.Y.; and Baltimore, Md. From the Department of Plastic Surgery, Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center; and the Division of Plastic, Reconstructive and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, and the Department of Pathology, University of Maryland Medical Center.
authors.forename: Arif
authors.initials: A
authors.lastname: Chaudhry
authors.forename: Michael
authors.initials: M
authors.lastname: Sosin
authors.forename: Branko
authors.initials: B
authors.lastname: Bojovic
authors.forename: Michael R
authors.initials: MR
authors.lastname: Christy
authors.forename: Cinthia B
authors.initials: CB
authors.lastname: Drachenberg
authors.forename: Eduardo D
authors.initials: ED
authors.lastname: Rodriguez
mesh_terms: D001706:Biopsy; D054445:Facial Transplantation; D006084:Graft Rejection / Q000473:pathology*; D006801:Humans; D008297:Male; D009061:Mouth Mucosa / Q000473:pathology*; D009297:Nasal Mucosa / Q000473:pathology*; D012867:Skin / Q000473:pathology*