O40: PRE-OPERATIVE MANAGEMENT AND SENSITISATION IN VASCULARIZED COMPOSITE ALLOTRANSPLANTATION: A SYSTEMATIC REVIEW

Abstract Introduction Vascularised composite allotransplantation (VCA) permits like-for-like reconstruction following extensive soft tissue injuries. The initial management of injury can lead to the development anti-HLA antibodies through injury, transfusion and cadaveric grafting. role antibody-mediated rejection, donor-specific graft rejection in context VCA remains unclear. This systematic review aimed determine whether pre-operative strategies influence immunological outcome VCA. Method A MEDLINE, EMBASE CINAHL using a PRISMA-compliant methodology up February 2019 was conducted. Pre-operative, procedural long-term data were collected recorded for all recipients on an individual patient basis. Result search revealed 3,847 records which 114 met inclusion criteria reported clinical related 100 patients who underwent 129 transplants. Trauma (50%) burns (15%) most frequent indications Of studies, only one acute resuscitative management. Fifteen (14.7%) sensitized prior reconstructive transplantation with 80% incidence first post-operative year. Seven demonstrated vasculopathy, whom had panel reactive antibodies. Conclusion Currently employed predispose antibodies, adding already complex challenge Early appropriate care is warranted loss where needs should be balanced against mitigate burden, particularly as becomes feasible option future coverage. Take-home message Acute may sensitise potential transplant major injury. warranted.