A major burn injury in a liver transplant patient.

Immunosuppressive therapy may aggravate the clinical course of a burned patient, primarily affecting wound healing and thus complicating permanent wound coverage. We hereby present the successful management of a 48-year-old female liver transplant recipient with a major burn injury, aiming to elucidate the effects of the patient's immunosuppression on surgical treatment. After admission to the Burns ITU, the patient underwent serial debridement of the burn and coverage with cryopreserved allografts. Despite immunosuppression, no prolonged survival of the allo-epidermis was documented. Nevertheless, a variable degree of vascularized allo-dermis was clinically identified. She subsequently underwent skin autografting and was discharged home with most of the wounds healed. Although there are isolated reports of survival of skin allografts in immunocompromised patients, in our case the allografted skin did not provide permanent wound coverage. However, it permitted a staged surgical management, allowing the immunosuppressive regime to change, the skin donor sites to heal and it also provided a dermal scaffold for successful skin autografting.