Banff VCA Consensus Statements Session
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1 Banff VCA Consensus Statements Session Linda C. Cendales, M.D. Durham, NC, USA On Behalf of the Banff VCA working group
2 Skin Containing VCA as a Monitoring Tool for Intestinal Transplantation Annemarie Weissenbacher, M.D. Oxford University Hospitals
3 Analysis of Oxford Intestinal transplantation and VCA Patients Does the addition of a VCA increase the immunological burden? Does VCA increase the incidence of de novo DSA? Do de novo DSA have an impact on graft survival?
4 Transplanted Cohort ITx recipients overall 24 isolated small bowel Tx VCA n=12 (50%) 8 modified multivisceral Tx VCA n=6 (75%)
5 Rejection Episodes 5 ITx rejection episodes in ITx only (5/14, 35.7%) 3 ITx rejection episodes in ITx+VCA (3/18, 16.7%) 7 Skin rejection episodes in ITx+VCA (7/18, 38.9%) NO bowel rejection without skin rejection!
6 Post Transplant Sensitisation De novo DSA post transplant 8/13 (61.5%) 6/16 (37.5%) No VCA VCA (Abdo. wall/sentinel skin flap) Increased dndsa Increased No DSA Unchanged
7 Results of the multivariate Cox regression analysis to evaluate independent predictors for long term graft survival Characteristic Wald HR 95% CI p value Recipient age at Tx Existence of dndsa dndsa class I dndsa class II dndsa class I+II
8 Summary Skin containing VCA seems to be a future leader for diagnosis of rejection sentinel skin Combining an intestinal transplant with an abdominal wall VCA does not increase the incidence of de novo DSA Multivariate analysis showed that the development of de novo DSA in intestinal transplantation is detrimental to the long-term survival of the graft
9 VCA pathologic scoring system in a preclinical model Ivy Rosales, M.D. Boston, MA, USA
10 A systematic pathologic component scoring system for skincontaining VCA was developed using porcine samples. Conclusions: Semi-quantitative systematic pathologic component scoring system that complements the Banff 2007 Working Classification Sufficient reproducibility Correlation with outcome Offers opportunity for validation in clinical samples Vascular lesions merit attention and inclusion in VCA pathologic evaluation
11 Jean Kanitakis, M.D. PhD Lyon, France
12 Graft Vasculopathy in the skin Transplant Int 2014
13 Vasculopathy in the skin Kanitakis J et al, Transplantation 2016
14 Allograft vasculopathy - Finger amputation Intimal thickening myointimal proliferation Arteritis CD3 CD20 Capillary thrombosis Kanitakis J et al, Transplantation 2016
15 The role of immunohistochemistry and additional tools in the diagnosis of VCA skin rejection David Elder, Philadelphia, USA
16 Three Biopsies from a Patient with Bilateral Hand Transplants Focal rash present (Specimen 3)
17 Specimen 3, Grade 2-3
18 Specimen 3, Grade 2-3
19 Grade 2-3, CD4 Grade 2-3, CD1a
20 Grade 2-3, CD8 Grade 2-3, CD3 Grade 2-3, CD68 Grade 2-3, CD4
21 Grade 2-3, Granzyme Grade 2-3, Perforin Grade 2-3, CD8 Grade 2-3, CD20
22 Suggestions for Revised Schema: Probability of Rejection after G.F. Murphy CLINICAL ASSESSMENT PATHOLOGY ACTION Minimal or no perivascular lymphocytes C-P disparity; consider repeat/serial biopsies Clinical suspicion Perivascular lymphocytes +/- lymphocyte-unassociated apoptosis (satellitosis) Perivascular lymphocytes + lymphocytic vasculopathy, &/or lymphocyte-associated apoptosis (satellitosis) Possible early rejection Probable rejection GRADE BWH Program in Dermatopathology Perivascular lymphocytes + spongiosis &/or parakeratosis &/or neutrophils/eosinophils Consider dermatitic mimic; re-biopsy G Murphy
23 Monitoring of human uterus transplantation with cervical biopsies - a provisional scoring system for rejection. Johan Mölne University of Gothenburg, Sweden
24 History of uterus transplantation First transplant in Saudi Arabia 2000 vascular thrombosis after 3 months Uterus tx from deceased donor in Turkey 2011 technical success but no childbirth First child born in Gothenburg 2014 Brännstrom M. Lancet 2015; 385: Utx trial started 1999, small and large animals, primates and finally humans 9 women transplanted, 2 early failures 6 healthy babies born so far
25 Today Several centers have started Utx trials Nov 2015 a living donor in China eleven living donor cases 6 in Dallas, USA 3 in Prague, Czech Republic 1 in Tubingen, Germany 1 in China five deceased donors 3 in Prague, Czech Republic 1 in Cleveland, USA 1 in Sao Paulo Brazil No children born yet Early failures reported in USA
26 Normal cervical biopsy Borderline changes Grade 1 rejection
27 Grade 2 rejection Grade 3 rejection
28 Summary normal borderline changes Grade 1 rejection Grade 2 rejection Grade 3 rejection After treatment (G1)
29 Thank you
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