Challenges in Cadaveric Skin Graft Survival in Organ Transplant Recipients on Immunosuppressive Regimens: A Case Report
Summary: Case report of two liver-kidney transplant recipients on chronic immunosuppression (tacrolimus/mycophenolate ± prednisone) who received cryopreserved cadaveric skin allografts (PureSkin) for lower-extremity wounds. Initial adherence at 2 weeks, but grafts disintegrated by 4-8 weeks despite therapy. Wounds granulated well but did not integrate grafts; patients declined STSG, opting for local care (one healed secondary intention, one died from pulmonary disease). Highlights unpredictable long-term allograft survival in immunosuppressed patients, with initial benefits but eventual rejection; suggests exploring local immunosuppression or alternatives like cellular matrices.
Key Highlights:
- Patient 1: 59M, trauma hematoma/necrosis; graft failed 4 weeks; healed secondary.
- Patient 2: 62M, necrotizing infection; graft failed 8 weeks; died pulmonary.
- Challenges: Immunosuppression prolonged initial survival but not integration.
- Lessons: Extended follow-up needed; consider alternatives in high-risk patients.
- Authors: Steven Tohmasi, Carolyn Tsung, Ariana Naaseh, Jennifer Yu, John P. Kirby, Lindsay M. Kranker.
Keywords: cadaveric graft, immunosuppression, transplant, rejection, lower extremity, Steven Tohmasi, John P Kirby