A 65-year-old man had extensive burns of the lower legs in 1991, at the age of 40 years. He was treated by nonvascularized and de-epithelialized, allogeneic split-thickness skin allograft and cyclosporine monotherapy for 2 months. Ulcers developed between 10 and 25 years after transplantation and a surgical debridement on the lower extremities was required. Analyses of the removed tissue allografts showed chronic antibody-mediated and cellular rejection with extensive and dense fibrosis, and diffuse capillary C4d deposits. An anti-DRB1*08:01, donor-specific antibody was present. A unique clinical condition with late immunopathological features of human skin chronic allograft rejection is reported.
Keywords: accommodation; alloantibody; clinical research/practice; ethics and public policy; organ transplantation in general; pathology/histopathology; rejection: antibody-mediated (ABMR); surgical technique; tolerance; vascularized composite and reconstructive transplantation.
© 2019 The American Society of Transplantation and the American Society of Transplant Surgeons.