Donor-specific tolerance permits burn allografting without increased sepsis.
Early excision and allografting of massive burns is beneficial. However, chronic immunosuppression, utilized to prolong allograft survival, increases the potential risk of infection. We have previously shown long-term skin allograft survival in mice with a 30% total body surface area (TBSA) burn by inducing donor-specific tolerance (DST) using only perigrafting administration of antithymocyte globulin (ATG) and donor bone marrow (DBM). Chronic immunosuppression is avoided. This study tests whether induction of DST compromises host resistance to infection. Resistance to a septic challenge created by cecal ligation and puncture (CLP) 10 days after a 30% TBSA burn was investigated in the following groups of mice: [table: see text] Positive blood cultures were documented for 97% of mortalities. Burn excision and grafting significantly (P less than or equal to 0.05) decreased mortality. No increased mortality was seen in allografted mice receiving ATG or ATG and DBM compared to isografted mice receiving no immunosuppression. These studies suggest that skin allografting with DST may permit the benefits of burn excision without the risks of infection seen with chronic immunosuppression.
Garrison
J L
JL
Department of Surgery, School of Medicine, East Carolina University, Greenville, North Carolina 27858.
Cunningham
P R
PR
Lust
R M
RM
Thomas
F T
FT
D000818:Animals; D000961:Antilymphocyte Serum / Q000494:pharmacology; D002056:Burns / Q000401:mortality / Q000601:surgery*; D007108:Immune Tolerance; D008297:Male; D051379:Mice; D018805:Sepsis / Q000517:prevention & control*; D016038:Skin Transplantation; D014019:Tissue Donors; D014184:Transplantation, Homologous
D000961:Antilymphocyte Serum