Open AccessAntibody‐mediated rejection in hand transplantation
Author(s) -
Weissenbacher Annemarie,
Hautz Theresa,
Zelger Bernhard,
Zelger Bettina G.,
Mayr Verena,
Brandacher Gerald,
Pratschke Johann,
Schneeberger Stefan
Publication year - 2014
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.12233
Subject(s) - medicine , rituximab , transplantation , cd20 , antibody , donor specific antibodies , allotransplantation , pathology , surgery , immunology , kidney transplantation
Summary Clinical relevance of antibody‐mediated rejection ( ABMR ) in vascularized composite allotransplantation ( VCA ) has not been defined. We herein describe a novel type of donor‐specific antibody ( DSA ) and B‐cell‐associated rejection in hand transplantation. In 2003, a bilateral forearm transplantation was performed on a 42‐year‐old male patient. In 2012, the patient presented with edematous hands and forearms without skin lesions. Punch skin biopsies revealed rejection grade Banff II . Immunohistochemical analysis identified large aggregates of CD 20 + lymphocytes with an architecture resembling lymph nodes. De novo DSA was found at a high level. Steroid treatment was ineffective, but administration of rituximab resulted in complete remission of clinical symptoms, evaporation of B‐cell aggregates, and disappearance of DSA . We herein report the first case of what we suggest is an ABMR in VCA occurring at 9 years after forearm transplantation. Rituximab therapy successfully reversed the event.