Abnormal Nailfold Capillaries in Patients after Hand Transplantation.

Dorota Sikorska,Andrzej Oko,Janusz Witowski,Katarzyna Korybalska,Kacper Nijakowski,Marek Karczewski,Włodzimierz Samborski,Mariusz Kusztal,Dorota Kamińska,Jerzy Jabłecki

doi:10.3390/jcm9113422

Abstract

Background: The development of graft vasculopathy may play a role in the long-term deterioration of hand grafts. The aim of study was to examine the patterns of the nailfold capillaries in hand transplant recipients. Methods: the study was performed on six patients who received hand transplantation. To normalize for the effect of immunosuppression an age- and sex-matched group of 12 patients with active kidney transplant was selected. As an additional control group, 12 healthy volunteers were recruited. Nailfold videocapillaroscopy was performed in all participants. Additionally, serum concentrations of vascular endothelial growth factor (VEGF) were measured. Results: Videocapillaroscopic examination of the hand allografts revealed significant abnormalities: including capillary disorganization and microhaemorrhages. The number of capillaries was reduced, the vessels were enlarged and branched. Surprisingly, similar, albeit slightly less pronounced, changes were seen in the nailfolds of healthy hands of the limb transplant recipients. In kidney transplant recipients the capillaroscopic pattern was general normal and comparable to healthy individuals. Moreover, serum concentrations of VEGF in all participants correlated with average capillary diameter in capillaroscopy. Conclusions: in hand transplant recipients advanced microvascular abnormalities are found in nailfold capillaroscopic pattern in both transplanted and own extremities connected with elevated levels of VEGF.

Highlights

The first successful hand transplantation was performed in 1998 in Lyon, France [1]
There are no studies on nailfold capillaroscopic patterns in patients after transplantations, but high levels of vascular endothelial growth factor (VEGF) have been demonstrated to associate strongly with vasculopathy seen during the rejection of cardiac transplants [15,16,17]
It has been proposed that nailfold capillaroscopic patterns and VEGF levels may serve as biomarkers of interstitial lung involvement in systemic sclerosis [33,34,35]

Summary

Introduction

The first successful hand transplantation was performed in 1998 in Lyon, France [1]. the lack of patient’s compliance with the immunosuppression regimen led eventually to transplant rejection in 2001, subsequent attempts of limb transplantation were a success. The aim of study was to examine the patterns of the nailfold capillaries in hand transplant recipients. Methods: the study was performed on six patients who received hand transplantation. To normalize for the effect of immunosuppression an age- and sex-matched group of 12 patients with active kidney transplant was selected. Similar, albeit slightly less pronounced, changes were seen in the nailfolds of healthy hands of the limb transplant recipients. In kidney transplant recipients the capillaroscopic pattern was general normal and comparable to healthy individuals. Serum concentrations of VEGF in all participants correlated with average capillary diameter in capillaroscopy. Conclusions: in hand transplant recipients advanced microvascular abnormalities are found in nailfold capillaroscopic pattern in both transplanted and own extremities connected with elevated levels of VEGF

Objectives

Discussion

Conclusion