Treatment of the severely burned child with skin transplantation modified by immunosuppressive therapy.

The IgG fraction of equine antithymocyte globulin administered by the intravenous and intramuscular route to two patients with severe thermal injury was associated with survival of the skin allografts to 19 and 42 days. In the second patient the IgG fraction was discontinued 28 days after skin grafting and rejection occurred 14 days later while the patient was receiving azathioprine and 1% topical hydrocortisone cream to the skin allografts. Although no comparison can be made between the immunosuppressive properties of antithymocyte globulin, azathioprine and topical steroids, skin allograft survival was prolonged temporarily until autograft skin from previous donor sites could be obtained. The use of skin allografts protected by immunosuppressive therapy in patients with severe thermal injury deserves further consideration.