Atypical acute rejection after hand transplantation

S. Schneeberger, V. S. Gorantla, R. P. Van Riet, M. Lanzetta, P. Vereecken, C. Van Holder, S. Rorive, M. Remmelink, A. Le Moine, D. Abramowicz, B. Zelger, C. L. Kaufman, W. C. Breidenbach, R. Margreiter, F. Schuind

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59 Scopus citations

Abstract

Skin rejection after hand transplantation is characterized by a maculopapular erythematous rash that may be diffuse, patchy or focal, and distributed over forearms and dorsum of the hands. This 'classical' pattern of rejection usually spares the skin of the palm and does not affect the nails. Herein, we report the experience on four cases presenting with an 'atypical' pattern of rejection that is novel in involving the palmar skin and the nails. All patients were young and exposed to repetitive and persistent mechanical stress of the palm. Characteristic features of rejection included a desquamative rash associated with dry skin, red papules, scaling and lichenification localized to the palm. Skin lesions were associated with nail dystrophy, degeneration, deformation or loss. Histology of the skin and nail bed revealed a lymphocytic infiltrate with predominance of T cells (CD3+, CD4+ and CD8+), with small numbers of B cells (CD20+ and CD79a+) and a low number of Forkhead transcription factor 3 (FOXP3)-positive cells in one patient. The lesions persisted over weeks to months, responded poorly to steroid treatment and were managed with antithymocyte globulin (ATG; Thymoglobulin, Genzyme, Cambridge, MA), alemtuzumab and/or intensified maintenance immunosuppression.

Original languageEnglish (US)
Pages (from-to)688-696
Number of pages9
JournalAmerican Journal of Transplantation
Volume8
Issue number3
DOIs
StatePublished - Mar 1 2008

Keywords

  • Composite tissue transplantation
  • Hand transplantation
  • Nail
  • Rejection
  • Skin

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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    Schneeberger, S., Gorantla, V. S., Van Riet, R. P., Lanzetta, M., Vereecken, P., Van Holder, C., Rorive, S., Remmelink, M., Le Moine, A., Abramowicz, D., Zelger, B., Kaufman, C. L., Breidenbach, W. C., Margreiter, R., & Schuind, F. (2008). Atypical acute rejection after hand transplantation. American Journal of Transplantation, 8(3), 688-696. https://doi.org/10.1111/j.1600-6143.2007.02105.x