Management of burn patients is linked to the development of anti-HLA antibodies in patients receiving cryopreserved skin allografts: A retrospective cohort.

Abstract

Skin allografts are used to cover wounds in patients with severe burns. Owing to the allogeneic nature of the tissue, rejection often limits its effectiveness to a few weeks. The aim of this study was to analyse the factors influencing sensitisation in skin allograft recipients and to evaluate the role of donor-recipient HLA mismatches in the humoral response of sensitised patients. Eighteen patients were enrolled in this single-centre, retrospective cohort study. Adult burned skin allograft recipients were selected through a retrospective chart review (2013-2023). Blood samples were taken for HLA tissue typing as well as donor-specific antibody detection. Patient demographic and clinical data and potentially HLA-sensitising events (skin allografts, blood transfusions, pregnancies) were collected. HLA typing of donors and recipients was compared. Anti-HLA antibodies were detected in 83.3% of patients. Variables associated with the use of skin allografts (such as the number of donors or the area used) were identified as causes of the allosensitisation response to HLA class I. The number of blood donors also influenced the alloresponse to HLA class II. Furthermore, the humoral alloresponse was focused on HLA class I within the skin allograft, mainly against the HLA-B locus. Our results suggest that sensitisation after skin allograft is a multifactorial event. On the basis of this research, minimising the number of donors per patient, optimising blood transfusions, reducing cold ischaemia time, and starting skin allografting as soon as possible after burn injury are wise.