Summary of Composite Tissue Graft section of 2011 Paris Banff meeting


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Dr. Linda Cendales meeting summary of composite tissue graft section of 2011 Eleventh Banff Conference on Allograft Pathology, June 6-10, 2011 in Paris, France.

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  • That has led us to a working classifcaiton that like the kidknye clasification will be a living docuemtn to change as the field changes
  • Summary of Composite Tissue Graft section of 2011 Paris Banff meeting

    1. 1. Vascularized Composite Allografts (VCA) Banff Linda C. Cendales, M.D. Assistant Professor of Surgery Division of Plastic Surgery and Division of Transplantation Director, Vascularized Composite Allotransplantation and the Laboratory of Microsurgery E MORY T RANSPLANT C ENTER
    2. 2. VCA Banff 2007 <ul><li>Reported VCA at the time of the meeting </li></ul><ul><ul><li>Hand Transplants: n=22 </li></ul></ul><ul><ul><li>Other VCA: </li></ul></ul><ul><ul><ul><li>Skin containing : 13 </li></ul></ul></ul><ul><ul><ul><li>Non- skin containing : 26 </li></ul></ul></ul>International Registry on Hand and Composite Tissue Transplantation
    3. 3. VCA Banff 2011 World Experience <ul><li>Reported VCA < 100 patients </li></ul><ul><li>Hand transplant patients </li></ul><ul><ul><li>N= 51 </li></ul></ul><ul><li>Other VCA: face, laryngx, abdominal wall, knee </li></ul><ul><ul><li>N= 43 </li></ul></ul>International Registry on Hand and Composite Tissue Transplantation, accessed June 9, 2011
    4. 4. Michael Mengel University of Alberta, Edmonton, Canada Laboratory Medicine and Pathology Alberta Transplant Applied Genomics Centre and Transcriptome Sciences Inc Chronic immune injury in solid organ transplantation
    5. 5. <ul><li>Dr. Mengel presented an excellent overview of chronic changes in solid organs </li></ul><ul><li>The topics discussed included: </li></ul><ul><ul><li>the deterioration of allografts, particularly in kidneys </li></ul></ul><ul><ul><li>Antibody-mediated causes are a major problem </li></ul></ul><ul><ul><li>Failure also due to other causes (e.g. recurrent disease, calcineurin inhibitor toxicity) </li></ul></ul><ul><ul><li>C4d deposition pattern in VCAs is not clear and probably cannot be currently relied upon </li></ul></ul>
    6. 6. Chronic Changes in Non-Human Primates Gerhard S. Mundinger, M.D. University of Maryland Medical Center, Baltimore, MD 11 th Banff Conference on Allograft Pathology Enghien-les-Bains, France June 8 th , 2011
    7. 7. <ul><li>Dr Mundinger presented the group’s experience in nonhuman primate models of face and vascularized fibula </li></ul><ul><li>Studies attempt to induce tolerance in VCAs </li></ul><ul><li>The group’s observations included lymphoid aggregates, which the investigators relate to as tertiary lymphoid organs (TLOs) </li></ul><ul><ul><li>The data presented included CD3, CD4, & CD20 stains </li></ul></ul><ul><li>Findings showed evidence for a notch/jagged pathway activation </li></ul><ul><li>Findings showed chronic rejection and transplant arteriopathy </li></ul><ul><li>Results demonstrated superficial vs deep histologic discrepancy </li></ul>
    8. 8. Histologic findings in late vascularized composite allotransplantation Jean Kanitakis Depts. of Dermatology/Dermatopathology Ed. Herriot Hospital Lyon, France 10th Banff Meeting - Paris, June 8, 2011
    9. 9. Presented an overview of the spectrum of histologic changes observed in patients grafted and/or followed in Lyon <ul><li>1st hand alloTx Sept 1998 2.5 yrs (amputation after IST discontinuation) </li></ul><ul><li>1st 2 e hand alloTx - Jan 2000 11 yrs </li></ul><ul><li>2 e hand alloTx Apr 2003 8 yrs </li></ul><ul><li>2 e hand alloTx Feb 2007 4 yrs </li></ul><ul><li>2 e hand alloTx Jul 2008 2 yrs </li></ul><ul><li>2 e hand alloTx Jul 2009 1.5 yrs </li></ul><ul><li>1st face alloTx Nov 2005 5 yrs </li></ul><ul><li>Face alloTx Nov 2009 1.5 yrs </li></ul>
    10. 10. <ul><li>Presented a variety of ancillary stains, including </li></ul><ul><ul><li>CD3, CD4, CD8, TIA-1, FOXP3, and C4d </li></ul></ul><ul><ul><li>C4d pattern is still not clear </li></ul></ul><ul><li>Differential diagnosis is broad </li></ul>
    11. 11. Polish Experience in Hand Transplantation Departament of General Surgery Trzebnica , Poland Adam Chełmoński, Jerzy Jabłecki, Agnieszka Hałoń, Aleksandra Klimczak
    12. 12. Presented the Polish Experience Total of 6 Hand Transplant Patients -5 unilateral -1 bilateral hand transplant wrist level – 2 unilat (2008,201 1) ,1 bilateral ( 2010 ) mid - forearm – 1 unilat ( 200 6 ) mid – arm – 2 unilat ( 2009,2010 ) The last case required two partial finger amputations: the cause is being studied
    13. 13. Louisville VCA Program Christina Kaufman PhD Vasculopathy in Vascularized Composite Allotransplantation (VCA)
    14. 14. <ul><li>Data demonstrated chronic changes in hand allografts as delineated in the 2007 VCA Banff consensus discussions manuscript </li></ul><ul><ul><li>Vascular intimal thickening </li></ul></ul><ul><ul><li>Nail changes </li></ul></ul><ul><ul><li>Loss of hair follicles </li></ul></ul><ul><li>Observations showed skin with a VCA Banff Grade 0 and marked concentric intimal and medial hypertrophy at the same time point in the same patient </li></ul><ul><li>Development of HLA alloantibodies in two patients </li></ul><ul><li>The Louisville group is using ultrasound BioMicroscopy Technology to follow vascular changes </li></ul>
    15. 15. VCA Banff Working Group Pre-meeting survey
    16. 16. <ul><li>University of Maryland </li></ul><ul><li>Johns Hopkins University School of Medicine </li></ul><ul><li>Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran </li></ul><ul><li>University of Pittsburgh Medical Center </li></ul><ul><li>Cleveland Clinic </li></ul><ul><li>Christine M. Kleinert Institute </li></ul><ul><li>University Paris </li></ul><ul><li>United States Department of Defense </li></ul><ul><li>Innsbruck Medical University </li></ul><ul><li>St. Hedwig's Hospital , Trzebnica </li></ul><ul><li>St Vincent's Hospital </li></ul><ul><li>Ed. Herriot hospital </li></ul><ul><li>Bridgman Woman’s Hospital </li></ul><ul><li>University of Oxford/NDS </li></ul><ul><li>Emory University </li></ul>
    17. 18. <ul><li>New pathological findings from the last Banff meeting </li></ul><ul><ul><li>Neointimal proliferation </li></ul></ul><ul><ul><li>Arteritis </li></ul></ul><ul><ul><li>Vasculopathy </li></ul></ul><ul><ul><li>Increasing C4d deposits </li></ul></ul><ul><ul><li>Expression of adhesion molecules </li></ul></ul><ul><ul><li>Capillary thromboses </li></ul></ul><ul><ul><li>Tertiary lymphoid organ development </li></ul></ul>
    18. 19. Topics to Discuss <ul><li>Chronic changes </li></ul><ul><li>Inflammation vs rejection </li></ul><ul><li>Antibody Mediated Rejection </li></ul><ul><ul><li>DSA - / +C4d /intimal hyperplasia </li></ul></ul><ul><li>Myointimal proliferation </li></ul><ul><li>Markers of chronic skin rejection </li></ul><ul><li>Pathological changes of sentinel flap vs functional transplant </li></ul>
    19. 20. VCA Banff Working Group Post-meeting survey
    20. 21. Thank you