Systemic sclerosis as a model of chronic rejection in facial composite tissue transplantation

Introduction: Chronic rejection remains a potential significant long-term problem of facial allograft transplantation. Scleroderma parallels chronic rejection in terms of its immunological pathophysiology and its histopathological processes. Through the analysis of facial changes in scleroderma we demonstrate how chronic facial allograft rejection may present and progress.

Methods: 129 consecutive patients with a clinical diagnosis of scleroderma were recruited into the study. Static facial disease assessment was carried out through the analysis of digital photographs. Facial motion dysfunction was assessed using a modified House-Brackmann Grading Scale and an established maximal static response assay. Psychological evaluation comprised the Derriford Appearance Scale short-form (DAS), the Noticeability and Worry score and the Hospital Anxiety and Depression Scale (HADS).

Results: Static disease severity as measured using an observer-rated disfigurement scale revealed all grades of disease in the scleroderma cohort - from mild through to severe. Significant positive correlations were seen between observer rated disfigurement and DAS24, Noticeability and Worry scores. No significant relationship could be seen between the indices of facial motion impairment and psychological scores.

Conclusions: Progressive facial deterioration seen over time in scleroderma provides a comprehensive spectrum of static and dynamic facial changes which may be encountered in chronic facial graft rejection. This study provides valuable insight into the potentially significant long-term sequelae of allogenic reconstructive transplantation.