Introduction

Vascularized composite allotransplants (VCA) allow reconstructions of extensive burns sequelae. Initial care requires blood transfusions and skin allografts that can all lead to HLA sensitization. We studied the presence and predictors for those antibodies that restrain VCA in burned candidates.

Patients and Methods

Patients with third degree burns over 40% of body surface from a single burn unit during 3 years were assessed for anti HLA immunization (Single antigen Assay, Luminex). Their Calculated panel reactive antibodies were estimated by the French national agency for organ procurement. The potential predictors of alloimmunisation were analyzed.

Results

Twenty-nine patients were assessed (including 11 women, all with pregnancy history), with an average age of 32±13 yo, overall burned surface of 54±11% including 36±12% of third degree with average Unit Burn Standard score of 165±45. Fifteen patients required skin allografts including 8 with cryopreserved skin grafts. Average Blood transfusion requirement was 36±13 packed red blood cells for an average stay in intensive care unit of 92±37 days. Panel Reactive Antibody were assessed at an average follow-up of 38±13 month after the burns and retrieved 15 hypersensitized patients (CPRA>85%). Univariate analysis retrieved the use of cryopreserved (p=0,0079) but not glycerolized (p=0,87) skin allografts, the number of PRBC (P=0,0443), and the number of procedures (p=0,0286) as predictors of sensitization. Multivariate analysis only retained the use of cryopreserved skin allograft (p=0,034) and pregnancy histories (p=0,043).

Conclusions

Over 50% of patients with extensive third degree burns were highly-sensitized. The use of cryopreserved skin allografts that seemed to be related to this risk of sensitization might be avoided in patients presenting facial or hand destructions by third degree burns.

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