ArticleJAMA facial plastic surgery2019
The Evolving Clinical Presentation of Acute Rejection in Facial Transplantation.
Article in JAMA facial plastic surgery, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Epidemiological and Surgical Insights Into Concomitant Ocular and Craniofacial Trauma and the Implications for Combined Face and Whole-eye Transplantation.Plastic and reconstructive surgery. Global open · 2026Article
- Chronic rejection models for vascularized composite tissue allotransplantation.Scientific reports · 2025Article
- Continuous oxygen monitoring to enhance ex-vivo organ machine perfusion and reconstructive surgery.Biosensors & bioelectronics · 2024Article
- Immunosuppressive strategies in face and hand transplantation: a comprehensive systematic review of current therapy regimens and outcomes.Frontiers in transplantation · 2024Review
- International consensus recommendations on face transplantation: A 2-step Delphi study.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2024Article
- Methods of ex vivo analysis of tissue status in vascularized composite allografts.Journal of translational medicine · 2023Review
- Real-Time Monitoring Using Multiplexed Multi-Electrode Bioelectrical Impedance Spectroscopy for the Stratification of Vascularized Composite Allografts: A Perspective on Predictive Analytics.Bioengineering (Basel, Switzerland) · 2023Article
- Recognizing Emotional Expression as an Outcome Measure After Face Transplant.JAMA network open · 2020Article
- Blood proteome profiling using aptamer-based technology for rejection biomarker discovery in transplantation.Scientific data · 2019Article
- MMP3 Is a Non-invasive Biomarker of Rejection in Skin-Bearing Vascularized Composite Allotransplantation: A Multicenter Validation Study.Frontiers in immunology · 2019Article
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Authors and funding
10 authors.
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Abstract
importanceAcute rejection is one of the most frequent complications in facial transplantation, with potentially severe consequences for the recipient if overlooked. Clinical signs, such as erythema or edema, are helpful to diagnose acute rejection in the early follow-up stage; however, it is not well known whether these clinical signs remain reliable markers of acute rejection beyond the second posttransplant year.
objectiveTo determine the diagnostic value of clinical signs of acute rejection after facial transplantation over time. DESIGN, SETTING, AND
participantsA retrospective, single-center cohort study was conducted of patients who underwent facial transplantation at Brigham and Women's Hospital between April 2009 and October 2014, with up to an 8-year follow-up. Medical records were reviewed until September 30, 2017. The medical records from 104 encounters with 7 patients who underwent partial or full facial transplantation were analyzed for symptoms of rejection, immunosuppressive therapy, and histopathologic findings. MAIN OUTCOMES AND MEASURES: The occurrence of 5 clinical signs of acute rejection were evaluated: erythema, edema, exanthema, suture line erythema, and mucosal lesions. Odds ratios (ORs) were calculated to determine the statistically significant association of these signs with the histopathologic diagnosis of rejection. In addition, tacrolimus blood levels, as a surrogate marker of immunosuppressive therapy, were evaluated.
resultsOf the 7 patients included in the study, 5 were men. The mean follow-up was 66 months (range, 35-101). Of 104 clinical encounters, 46 encounters (44.2%) represented rejection episodes and 58 encounters (55.8%) represented no-rejection episodes. Beyond 2 years posttransplantation, only erythema (OR, 6.53; 95% CI, 1.84-20.11; P = .004) and exanthema (OR, ∞; 95% CI, 2.2-∞; P = .004) were demonstrated to be reliable clinical signs of acute rejection in facial transplantation. There was also a statistically significant association of subtherapeutic tacrolimus levels with late rejection episodes (OR, 3.79; 95% CI, 1.25-12.88; P = .03). In addition, the occurrence of subclinical rejection was more frequent during later follow-up times (7 [24.1%] late rejections vs 1 [5.9%] early rejection). Five of 8 subclinical rejections (62.5%) were associated with subtherapeutic tacrolimus levels. CONCLUSIONS AND RELEVANCE: Clinical signs of acute rejection in facial transplantation appear to be of limited diagnostic value, particularly after the second postoperative year. Until alternative biomarkers for rejection are identified, protocol skin biopsies will remain necessary for guiding assessments of allograft rejection. LEVEL OF EVIDENCE: 3.
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