CD3+-Mediated Rejection and C4d Deposition in Two Composite Tissue (Bilateral Hand) Allograft Recipients After Induction With Alemtuzumab

Background. New therapies are being introduced in reconstructive transplant surgery to enhance composite tissue allograft survival. Methods. Alemtuzumab was used in two bilateral hand allograft recipients to cause lymphocyte depletion. Results. Although profound leukopenia and lymphopenia developed, several episodes of acute rejection occurred both in the early and late posttransplant period. Cell-mediated rejection was diagnosed during acute rejection episodes. Intraluminal C4d deposits were found in the capillaries not only accompanying cellular rejection, but also in the absence of clinical rejection. However, their significance is unclear because donor-specific antibodies were absent, there were no pathological signs of injury, allograft function was not impaired, and clinical signs of rejection resolved. Conclusion. These findings suggest that alemtuzumab may not prevent cell-mediated rejection of a hand allograft transplant. Furthermore, C4d deposition warrants attention in clinical composite tissue allotransplants.