title: Sensitization and desensitization of burn patients as potential candidates for vascularized composite allotransplantation.
abstract: Sensitization describes the acquired ability of the immune system to react to foreign human leukocyte antigens (HLA) by producing antibodies and developing memory cells. In the field of transplantation, recipient preformed HLA antibodies due to previous sensitization have been identified - beneath ABO incompatibility - as a major factor for acute graft rejection. Several reasons for sensitization have largely been studied, such as previous blood transfusions, pregnancies or former transplants. Recent studies indicate that the use of assist devices (e.g. ECMO) or cadaveric skin allotransplantation providing temporary coverage in burn patients may lead to additional sensitization. As vascularized composite allotransplantation (VCA) has become a rapidly advancing therapeutic option for reconstruction of complex tissue defects in burns, it seems even more important to become familiar with immunological principles and to be cautiously aware of both sources of sensitization and therapeutic concepts in burns avoiding sensitization. This may also include emergency VCAs in burn patients as potential strategy for early definitive reconstruction avoiding procedures triggering HLA antibody formation. We hereby provide an overview on current evidence in the field of pre- and peritransplant sensitization, followed by posttransplant strategies of desensitization and their potential impact on future treatments of burn patients.
authors.affiliation: Division of Plastic Surgery and Hand Surgery, Burn Center, University Hospital Zurich, Switzerland. Electronic address: holger.klein@usz.ch.
authors.forename: H J
authors.initials: HJ
authors.lastname: Klein
authors.affiliation: Division of Hematology, University Hospital Zurich, Switzerland.
authors.forename: U
authors.initials: U
authors.lastname: Schanz
authors.affiliation: Service de Chirurgie Plastique et Reconstructrice, Hôpital Européen Georges Pompidou - Assistance Publique - Hôpitaux de Paris, Université Paris Descartes, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Hivelin
authors.affiliation: Division of Plastic Surgery and Hand Surgery, Burn Center, University Hospital Zurich, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Waldner
authors.affiliation: Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland.
authors.forename: V
authors.initials: V
authors.lastname: Koljonen
authors.affiliation: Division of Plastic Surgery and Hand Surgery, Burn Center, University Hospital Zurich, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Guggenheim
authors.affiliation: Division of Plastic Surgery and Hand Surgery, Burn Center, University Hospital Zurich, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Giovanoli
authors.affiliation: Department of Plastic Surgery and Starzl Transplant Institute, University of Pittsburgh Medical Center, Pittsburgh, USA.
authors.forename: V S
authors.initials: VS
authors.lastname: Gorantla
authors.affiliation: Department of Internal Medicine, Cantonal Hospital Graubuenden, Chur, Switzerland; Interdisciplinary HLA Typing Laboratory, University Hospital Zurich, Switzerland.
authors.forename: T
authors.initials: T
authors.lastname: Fehr
authors.affiliation: Division of Plastic Surgery and Hand Surgery, Burn Center, University Hospital Zurich, Switzerland; Department of Plastic Surgery and Starzl Transplant Institute, University of Pittsburgh Medical Center, Pittsburgh, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Plock
mesh_terms: D002056:Burns / Q000601:surgery*; D003888:Desensitization, Immunologic / Q000379:methods*; D054445:Facial Transplantation; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control*; D006680:HLA Antigens / Q000276:immunology; D063987:Hand Transplantation; D006801:Humans; D007114:Immunization / Q000379:methods*; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D010956:Plasmapheresis; D063986:Vascularized Composite Allotransplantation / Q000379:methods*
chemical_list: D006680:HLA Antigens; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors
keywords: Composite tissue allotransplantation; Face transplantation; HLA; Hand transplantation; IVIG; Plasmapheresis; Rejection