ABSTRACT
Composite tissue allotransplantation (CTA) is a novel transplantation discipline to treat functional tissue or limb defects. Since a majority of CTA grafts were vascularized grafts, it is also known as vascularized composite allotransplantation (VCA). The grafts of CTA/VCA consist of two or more types of allogeneic skin, subcutaneous tissue, bone, muscle, nerve and vessel, etc. Most of CTA/VCA grafts contain skin tissues, which possess the highest antigenicity. Acute rejection after transplantation is the primary obstacle leading to CTA/VCA graft failure and primary graft dysfunction. Hence, histopathological characteristics of skin rejection in CTA/VCA grafts have become the primary hotspot. In this article, pathological features of CTA/VCA rejection, Banff classification in 2007 and related research progress were reviewed, aiming to provide reference for the diagnosis and treatment of rejection and other complications of CTA/VCA.
ABSTRACT
BACKGROUND: Graft-versus-host disease(GVHD) refers to the spectrum of organ dysfunction that occurs when immunocompetent leukocytes attack specific tissue in a relatively immunocompromised host. The most common clinical setting for GVHD is after bone marrow transplantation(BMT). Acute GVHD occurs in about 40% to 50% of HLA-matched allogeneic transplants and skin is the most commonly involved. Despite intense interest in the GVHD, little is known regarding the histopathologic change in cutaneous graft-versus-host reaction(GVHR). OBJECTIVE: We investigated the clinical and histological features of acute cutaneous GVHR in recipients receiving allogenic BMT. METHODS: On the basis of the patients' charts, photographs and biopsy specimens, we investigated the clinical manifestations and histological characteristics of acute cutaneous GVHR in 70 patients from January 1, 1998 through December 31, 1999. RESULTS: The most common cutaneous involvement sites are the chest(48.6%) and other frequent site are the face(21.4%), palm(20.0%), and extremities(10.0%). The clinical grades of 70 patients of acute cutaneous GVHR were 31 patients(44%) for grade 1, 25 patients (36%) for grade 2, 14 patients(20%) for grade 3, and 0 patient(0%) for grade 4. Clinically, acute cutaneous GVHR mainly presented as pruritic erythematous maculopapules or patches. Histopathologic grades of 70 patients of acute cutaneous GVHR were 25 patients(36%) for grade 1, 38 patients(54%) for grade 2, 7 patients(10%) for grade 3 and 0 (0%)patinet for grade 4. Histologically, the most common epidermal change in acute cutaneous GVHR is vacuolar degeneration (95.6%). Other epidermal findings are epidermal dyskeratotic cell(76.5%), hyperkeratosis(61.8%), spongiosis(61.8%), exocytosis(61.8%), atrophy(52.9%), and parakeratosis(13.2%), acanthosis(11.8%) and subepidermal cleft(10.0%) are rarely seen. In addition, dermal changes include perivascular lymphohistiocytic infiltration(94.1%), telangiectasia(57.4%), pigmentary incontinence(44.1%), endothelial swelling(33.8%), band-like infiltration(30.8%), neutrophilic infitraion (20.6%), periappendageal infiltration(14.7%) and extravasation of erythrocytes(13.2%).
Subject(s)
Humans , Biopsy , Bone Marrow Transplantation , Bone Marrow , Graft vs Host Disease , Immunocompromised Host , Leukocytes , Neutrophils , SkinABSTRACT
Objective:To study the effect of Cyclosporine A(CSA) on inhibiting graft versus host reaction(GVHR) occured in hu PBL/SCID chimeras and to stably establish EBV induced lymphoma models.Methods:Human peripheral blood lymphocyts were isolated and were inoculated intraperitoneally into SCID mice.Mice were infected with EBV and injected intraperitoneally with CSA.Human sIL 2R in the serum of hu PBL/SCID chimeras were analyzed by ELISA.Results:No mouse was dead in CSA group,whereas 15 mice of the other three groups died of GVHR.The medium life span of no CSA administration mice was 17 days,and motalities were 55.56%(5/9),30.43%(7/23),42.86%(3/7)respectively.The difference was statistically significant between CSA group and the other groups.The levels of human sIL 2R were stable in CSA group while increased gradually in experimental infertion the groups without CSA.Difference was significant at day 15 and day 22 between the EBV infection group without CSA and with CSA administration.Of 38 survival SCID mice,24 mice developed tumors in their body cavities.Conclusion:CSA can strikingly inhibit GVHR that may occur in hu PBL/SCID mice,that could help practical to stably establish the lymphoma models.
ABSTRACT
Objective To manufacture rapamycin (RPM)-a new type immunosuppressant made in our country and investigate its immunosuppressive mechanism.Methods The effect of RPM on mouse splenocyte (Tc) proliferation induced by ConA,splenocyte (Bc) proliferation induced by LPS,DTH induced by DNCB and rat GVHR were studied.Results RPM obviously restrained the proliferation of Tc with IC50=1 nmol/L,significantly lower than IC50(10 nmol/L) of CsA (P＜0.05).RPM evidently repressed the proliferation of Bc with IC50=1 nmol/L significantly lower than IC50＞10 nmol/L of CsA(P＜0.05).RPM inhibited murine DTH to DNCB with ED50:1.8 mg/kg,significantly lower than ED50＞30mg/kg of CsA(P＜0.05).RPM controlled rat's GVHR with ED50=3 mg/kg,significantly lower than ED50≥30 mg/kg of CsA(P＜0.05).Conclusions RPM can inhibit lymphocytic proliferation and DTH,GVHR more markedly than CsA and they have combined efforts.