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Defining The Role Of Skin And Mucosal Biopsy In Facial Allotransplantation: A 2-year Review And Analysis Of Histology
Arif Chaudhry, M.D.1, Michael Sosin, M.D.2, Branko Bojovic, M.D.2, Michael R. Christy, M.D.2, Cinthia B. Drachenberg, M.D.3, Eduardo D. Rodriguez, M.D., D.D.S.1.
1New York University Langone Medical Center, New York, NY, USA, 2R Adams Cowley Shock Trauma Center/University of Maryland Medical Center, Baltimore, MD, USA, 3University of Maryland Medical Center, Baltimore, MD, USA.

PURPOSE: The implications of allograft skin and mucosal biopsy findings on classification of rejection and treatment remain unclear.
METHODS: Following facial allotransplantation, scheduled surveillance allograft skin and mucosal biopsies were obtained. Clinical concern for acute rejection prompted biopsies off schedule. Compilation of biopsy results, Banff grading, immunosuppression, and clinical correlation were critically reviewed for a 2-year follow up.
RESULTS: A total of 39 biopsies at 21 time points were obtained for analysis including both allograft skin (n=21) and mucosa (n=18). The patient had 3 episodes of acute rejection warranting treatment. Discordance between skin and mucosa occurred in 55.6% of biopsies (p=0.01). Mucosa concordance with the clinical evaluation occurred in 38.9% of biopsies (p=0.02), and skin concordance with clinical evaluation was present in 81% of biopsies (p=0.01).
CONCLUSION: The clinical utility of mucosal biopsy remains elusive. Our experience suggests that mucosal biopsies or skin biopsies, alone, should not drive the decision-making process in treatment. Skin biopsies are more likely to confirm clinical suspicion of rejection than mucosal histology. Data from other institutions is lacking, and future reporting may help elucidate the role of mucosal and skin biopsy in facial allotransplantation.


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