Topical tacrolimus and steroids modulate T cells in acute rejection of hand allotransplantation: Two case reports

Acute rejection is not uncommon after vascularized composite allotransplantation. We reported the effects of adjunctive topical immunosuppressant with topical tacrolimus (Protopic®) and steroid cream (Clobetasol®) in the management of acute rejection in two hand transplantation patients. Case 1 is a...

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Bibliographic Details
Published in:Microsurgery 2020-02, Vol.40 (2), p.217-223
Main Authors: Chen, Yi‐Ting, Huang, Shun‐Chen, Chen, Chien‐Chang, Lim, Lee‐Moay, Lu, Po‐Liang, Hou, Ya‐Ping, Fu, Yin‐Chih, Chen, Chia‐Hsin, Kuo, Yur‐Ren
Format: Article
Language:English
Subjects:
Biopsy
Case reports
CD20 antigen
CD3 antigen
Cell activation
Forearm
Foxp3 protein
Globulins
Graft rejection
Immunoregulation
Lymphocytes
Lymphocytes T
Maintenance
Methylprednisolone
Mycophenolate mofetil
Mycophenolic acid
Occupational accidents
Occupational safety
Prednisone
Rejection
Steroid hormones
Steroids
Tacrolimus
Therapy
Thymocytes
Transplantation
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Summary:Acute rejection is not uncommon after vascularized composite allotransplantation. We reported the effects of adjunctive topical immunosuppressant with topical tacrolimus (Protopic®) and steroid cream (Clobetasol®) in the management of acute rejection in two hand transplantation patients. Case 1 is a 45‐year‐old male with distal forearm deficit 4 years ago and Case 2 is a 30‐year‐old male with a proximal forearm deficiency 2 years ago, respectively. Both of them suffered from occupational accident and received hand allotransplantation. Induction was performed with antithymocyte globulins and methylprednisolone. Maintenance therapy consisted of tacrolimus (FK506), mycophenolate mofetil, and prednisone. Both cases experienced acute rejection, which we treated with topical tacrolimus and Clobetasol for 2 weeks, combined with systemic immunosuppressant maintenance therapy without adding pulse‐steroid therapy. Clinically, both cases recovered after adjunctive treatments. The skin biopsies showed significantly decreased perivascular lymphocyte infiltration after topical treatment. Immunohistochemical staining showed that CD3+ T‐cells and CD20+ B‐cells were suppressed in the recovery phase. FoxP3‐positive regulatory T cells were increased after treatment. Topical tacrolimus and Clobetasol as an adjunctive treatment with maintenance systemic immunosuppressives may be useful to control acute rejection, which correlated with modulation of lymphocyte activation, especially T cells. The treatment needs further investigation with gaining more comparable data.
ISSN:0738-1085
1098-2752
DOI:10.1002/micr.30439