Plastic Surgery Research Council
Members Only  |  Contact  |  PSRC on Facebook

Back to Annual Meeting Program


ANTI HLA IMMUNISATION RELATED TO SKIN ALLOGRAFT IN EXTENSIVELY BURNED PATIENTS: ASSESSMENT IN POTENTIAL CANDIDATES FOR VASCULARIZED COMPOSITE ALLOTRANSPLANTS.
Presenter: Mikael Hivelin, MD, PhD
Co-Authors: DUHAMEL PD; SUBERBIELLE CS; JACQUELINET CJ; AUDRY BA; BARGUES LB; BEY EB; LANTIERI LL
Henri Mondor HospitalUniversity Paris 12

Introduction: Vascularized composite transplants (VCA) offers rehabilitations options to extensive facial or hand burns. Initial care requires massive repeated blood transfusions and skin allografts, glycerolized or cryopreserved that can all lead to HLA sensitization. We studied the presence for those antibodies that can dramatically restrain VCA in potential burned candidates, and their predictors.

Patients and Methods: Patients with third degree burns over 40% of body surface from a single burn unit from 2007 to 2010 were assessed for anti HLA immunization (Single antigen Assay, LuminexÆ). Their impact on the access to transplants including VCA was estimated with virtual crossmatch to for calculated panel reactive antibodies (CPRA) by the French national agency for organ procurement (Agence de la BiomÈdecine). Predictors of alloimmunisation: transfusions, skin allografts and of pregnancy histories 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 (UBS) score of 165(±45). Fifteen patients required skin allografts (average surface of 3562 cm2) including 8 with cryopreserved skin grafts. Average Blood transfusion requirement was 36(±13) packed Red blood cells (PRBC) for an average stay in intensive care unit of 92(±37) days.Panel Reactive Antibody (PRA) were assessed at an average follow-up of 38(±13) month after the burns and retrived from 18 to 15 hypersensitized patients (CPRA>85%) weither transplantations were sex-matched or not. 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 (CSA) (p=0,034) and pregnancy histories (p=0,043).

Conclusions: Over 50% of patients with extensive third degree burns present counter-indications to transplantations, including VCA, due to HLA-hypersen


Back to Annual Meeting Program