Immunohistochemical Analysis of Lymphocyte Populations in Acute Skin Rejection: The University Health Network Addition to the Banff Classification

Siba Haykal; Natasha Barone; Sara Rostami; Sajad Moshkelgosha; Stephen Juvet; Shaf Keshavjee; Danny Ghazarian

doi:10.1097/GOX.0000000000004831

Immunohistochemical Analysis of Lymphocyte Populations in Acute Skin Rejection: The University Health Network Addition to the Banff Classification

Plast Reconstr Surg Glob Open. 2023 Mar 3;11(3):e4831. doi: 10.1097/GOX.0000000000004831. eCollection 2023 Mar.

Authors

Siba Haykal^{1

2

3}, Natasha Barone³, Sara Rostami¹, Sajad Moshkelgosha¹, Stephen Juvet¹, Shaf Keshavjee¹, Danny Ghazarian⁴

Affiliations

¹ Latner Thoracic Surgery Research Laboratories, Toronto General Hospital Research Institute, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada.
² Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
³ Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada.
⁴ Department of Pathology, University Health Network, University of Toronto, Toronto, ON, Canada.

Abstract

Acute rejection in vascularized composite allotransplantation has been identified using the Banff 2007 working classification. We propose an addition to this classification based on histological and immunological assessment within the skin and subcutaneous tissue.

Methods: Biopsies from vascularized composite transplant patients were obtained at scheduled visits and whenever skin changes occurred. Histology and immunohistochemistry were performed on all samples, looking at infiltrating cells.

Results: Observations were made specifically related to each component of the skin, including the epidermis, dermis, vessels, and subcutaneous tissue. Our findings led to the establishment of the University Health Network addition of skin rejection.

Conclusions: The high rate of rejection where the skin is involved requires novel techniques for early detection. The University Health Network skin rejection addition can serve as an adjunct to the Banff classification.