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Meta-Analysis
. 2025 May;51(4):107424.
doi: 10.1016/j.burns.2025.107424. Epub 2025 Feb 14.

Do allografts present a risk to burn patients? Allografts and HLA-sensitization

Joshua Tsai  1 , Luka Kim  2 , Isabel Jones  3 , Samuel Culbert  4 , Tuna Ozyurekoglu  5
Affiliations
Free article
Meta-Analysis

Do allografts present a risk to burn patients? Allografts and HLA-sensitization

Joshua Tsai et al. Burns. 2025 May.
Free article

Abstract

Objective: This meta-analysis aimed to quantify sensitization rates following allograft usage and determine whether allografts have an increased risk of long-term sensitization compared to alternative therapies in burn patients.

Methods: Systematic review, meta-analysis and meta-regression of post-operative sensitization in burn patients were performed following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidance (Prospero registration: CRD42024497137). Database searches were conducted on MEDLINE, Embase, CENTRAL using ProQuest Dialog. We included all studies reporting post-operative sensitization in burn patients that were not case series or singular case reports. Meta-analysis was used to compare the risk of sensitization for allograft versus alternative therapies.

Results: Six studies (Allograft Patients: 71; Non-Allograft Patients: 95) were included (n = 166). Overall, 73 % (CI: 39 %-92 %) of burn patients were sensitized following allograft. Patients receiving allograft were at a significantly increased risk of sensitization (OR 13.14 [95 % CI: 1.32-131.00]). However, on sub-group analysis, when directly comparing patients who received allograft and transfusion versus those who received transfusion alone, there was not a significantly increased risk of sensitization (OR 7.68 [95 % CI:.61-95.86]).

Conclusion: Allograft is associated with a significantly increased risk of sensitization in burn patients. However, it is not clear whether burn patients already receiving transfusion will have an increased risk of sensitization from adding allograft. Further studies are required to demonstrate the multifactorial causes of sensitization within the burned population to explain the significance of the contribution from allograft and/or transfusion reported within the literature. Clinicians must carefully weigh the immediate benefits of allografts against the potential long-term challenges of sensitization, especially where alternative wound therapies are possible.

Keywords: Allograft; Burns; Human leukocyte antibody; Sensitization; Transfusion.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that there is no source of financial or other support, or any financial or professional relationships which may pose a competing interest.