1. Anti-human Leukocyte Antigen Immune Sensitization Effects of Cryopreserved Allograft and Blood Transfusion
- Author
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Edward J. Caterson, Laura E Cooper, Phillip M. Kemp Bohan, Leopoldo C. Cancio, Victoria Hatem, John Fletcher, Rodney K. Chan, and David H. Tassin
- Subjects
Adult ,Graft Rejection ,Male ,medicine.medical_specialty ,Resuscitation ,Blood transfusion ,medicine.medical_treatment ,Blood Component Transfusion ,030230 surgery ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,HLA Antigens ,Isoantibodies ,Internal medicine ,medicine ,Humans ,Sensitization ,Cryopreservation ,Vascularized Composite Allotransplantation ,Body surface area ,biology ,business.industry ,Rehabilitation ,Panel reactive antibody ,030208 emergency & critical care medicine ,Skin Transplantation ,Middle Aged ,Cross-Sectional Studies ,medicine.anatomical_structure ,Emergency Medicine ,biology.protein ,Female ,Surgery ,Antibody ,Burns ,Packed red blood cells ,business ,Total body surface area - Abstract
Vascularized composite allotransplantation (VCA) is the most advanced reconstructive technique available to patients who suffer devastating burns to the limbs or face. However, VCA requires donor–recipient matching. Burn patients have been reported to experience sensitization, or the development of anti-human leukocyte antigen antibodies, during resuscitation and wound coverage, potentially precluding them from future VCA. This study sought to investigate the contributions of both blood and allograft to sensitization in burn patients. Four groups were compared: burn patients who received blood products and allograft (group 1), burn patients who received blood products only (group 2), trauma patients who received blood products only (group 3), and healthy volunteer controls (group 4). The average calculated panel-reactive antibody (indicating sensitization) was higher in group 1 compared to group 4 (P = .035). Additionally, the incidence of severe sensitization was higher in group 1 relative to the other groups (P = .049). When comparing groups of patients who had no sensitization, mild sensitization, moderate sensitization, and severe sensitization, there were no significant differences in age, sex, blood products received, total body surface area burned, or allograft used between groups, though severely sensitized patients tended to have greater total body surface area involvement and received more units of packed red blood cells and allograft (P = .079, P = .196, and P = .072, respectively). We therefore conclude that while burn patients who received allograft and blood demonstrated a higher incidence of anti-human leukocyte antigen sensitization relative to healthy controls, this difference cannot solely be attributed to either allograft use or transfusion.
- Published
- 2020