Original article
Long-term follow-up of patients undergoing autologous noncultured melanocyte-keratinocyte transplantation for vitiligo and other leukodermas

https://doi.org/10.1016/j.jaad.2017.01.056Get rights and content

Background

Persistence of pigmentation after a melanocyte-keratinocyte transplantation procedure (MKTP) is an important consideration for efficacy.

Objective

We sought to determine long-term repigmentation of MKTP in vitiligo and other leukodermas.

Methods

A retrospective review of electronic medical records was conducted for all MKTPs performed at Henry Ford Hospital between January 2009 and April 2014. Repigmentation was assessed by a 5-point grading scale (poor to excellent) and Vitiligo Area Scoring Index (VASI).

Results

One hundred patients had MKTP performed at 236 anatomically-based lesions (ABLs); 63 patients with 157 ABLs had long-term data available (12-72 months; median, 24 months). Segmental vitiligo, nonsegmental vitiligo, and physical leukoderma demonstrated improvement in VASI scores: −75.6 ± 24.6%, −59.2 ± 36.6%, and −32.4 ± 33.5%, respectively. In vitiligo, at 24, 48, and 72 months after MKTP, 53%, 64%, and 53% of ABLs, respectively, maintained >75% repigmentation. Skin phototype, age, and anatomic location of ABLs had no significant effect on the outcome of treatment.

Limitations

Limitations of the study include the retrospective design with uncontrolled, postoperative adjuvant treatments and inconsistent compliance to scheduled follow-up evaluations.

Conclusions

MKTP provides satisfactory long-term repigmentation in the majority of appropriately selected patients with leukoderma. MKTP can maintain repigmentation for at least 72 months.

Section snippets

Patient selection

A Henry Ford Hospital Institutional Review Board–approved (IRB No. 8391), retrospective review of electronic medical records was performed for all patients who underwent MKTP at our facility between January 2009 and April 2014. All patients for whom clinical information was available for at least 12 months after the procedure were included in the study.

Inclusion criteria for MKTP were stable vitiligo (focal/segmental vitiligo [SV] or nonsegmental vitiligo [NSV] without fingertip involvement) or

Patient characteristics

One hundred patients had 117 MKTPs performed on 236 ABLs between January 2009 and April 2014 (Fig 1). Many patients underwent treatment of multiple ABLs at a single MKTP session. Twelve patients (5 SV and 7 NSV) underwent 2 to 5 MKTPs involving the same or different ABLs. MKTP was performed on a broad ethno-racial population (white, 42%; South Asian, 33%; African-American, 10%; East Asian, 6%; Middle Eastern, 5%; and Hispanic, 4%). The face and neck comprised the majority of treated ABLs,

Discussion

Since debuting in the literature in 1992,1 noncultured, autologous MKTP has undergone sequential modifications to ultimately become a simpler, 2- to 4-hour outpatient procedure offering good repigmentation of leukodermas with a high degree of patient satisfaction (average satisfaction score, 8.5 of 10; zero = not at all, 10 = very much).4

Our study demonstrated the dynamic change in short-term (6 months) and long-term (>12 months) MKTP outcomes, based on a large number of cases and several types

Conclusions

MKTP is an excellent option for achieving long-term repigmentation in patients with vitiligo and other leukodermas. Although the majority of MKTP repigmentation occurs within the first 6 months, additional pigmentation can develop and persist until 72 months. It is possible that this long-term repigmentation could still be enhanced through the use of adjuvant treatments (before and/or after MKTP) and by adjusting the viable melanocyte concentrations in cell suspension. This study further

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  • Cited by (0)

    This study was partially supported by the Shahani Foundation and Multicultural Dermatology Fund, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan.

    Disclosure: Dr Hamzavi had served as a consultant for Johnson & Johnson, was an investigator for Johnson & Johnson, Ferndale Laboratories, Estee Lauder, and Allergan and had received honoraria from Allergan. Dr Lim had served as a consultant for Pierre Fabre and had received grants and research support from Estee Lauder, Ferndale Laboratories, and Allergan. Dr Griffith had served as an investigator for Ferndale Laboratories. Drs Silpa-Archa, Huggins, Henderson, Kerr, and Mulekar and Mr Jacobsen had no conflicts of interest to declare.

    This study was presented as a poster presentation at the 23rd World Congress of Dermatology, Vancouver, Canada (June 2015). Contents of this manuscript have not been previously published and are not currently submitted elsewhere for publication.

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