Noninvasive Monitoring of Immune Rejection in Face Transplant Recipients.
BACKGROUND
Chronic rejection leading to allograft loss remains a significant concern after facial allotransplantation. Chronic rejection may occur without clinical signs or symptoms. The current means of monitoring is histologic analyses of allograft biopsy specimens, which is both invasive and impractical. Prior data suggest that chronic rejection is associated with changes in intima and media thickness of vessels in arms and solid organ allografts; such data have not been published for face transplant recipients.


METHODS
The authors used a 48-MHz transducer to acquire images of the bilateral facial, radial, dorsalis pedis and, if applicable, sentinel flap arteries in five face transplant recipients (8 months to 4.5 years after transplantation) and five control subjects. The authors assessed the intima, media, and adventitia thickness plus lumen and the total vessel diameter and area.


RESULTS
Face transplant recipients had thicker intima in all sites compared with controls, but the ratio of the intimal thickness of facial and radial arteries was similar in face transplant recipients compared with controls (1.00 versus 0.95; p = 0.742). Intraobserver correlation showed reliable reproducibility of the measurements (r = 0.935, p ≤ 0.001). Interobserver correlation demonstrated reproducibility of intima measurements (r = 0.422, p ≤ 0.001).


CONCLUSIONS
The authors demonstrate that ultrasound biomicroscopy is feasible for postsurgical monitoring, and have developed a new benchmark parameter, the facial artery-to-radial artery intimal thickness ratio, to be used in future testing in the setting of chronic rejection.


METHODS
Diagnostic, IV.
Boston, Mass.; New York, N.Y.; and Bochum and Heidelberg, Germany From the Division of Plastic Surgery, Department of Surgery, the Applied Imaging Science Laboratory, Department of Radiology, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School; the Center for Advanced Imaging Innovation and Research, Department of Radiology, New York University School of Medicine, and the Sackler Institute of Graduate Biomedical Sciences, New York University; and the Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, and the Department of Plastic Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg.
Maximilian
M
Kueckelhaus
Amir
A
Imanzadeh
Sebastian
S
Fischer
Kanako
K
Kumamaru
Muayyad
M
Alhefzi
Ericka
E
Bueno
Nicole
N
Wake
Marie D
MD
Gerhard-Herman
Frank J
FJ
Rybicki
Bohdan
B
Pomahac
D064591:Allografts; D054445:Facial Transplantation / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000276:immunology*; D006801:Humans; D008297:Male; D015166:Monitoring, Immunologic / Q000379:methods*; D008991:Monitoring, Physiologic / Q000379:methods; D015588:Observer Variation; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D066027:Transplant Recipients; D014181:Transplantation Immunology / Q000502:physiology*; D017539:Tunica Intima / Q000473:pathology; D018608:Ultrasonography, Doppler