IgG DONOR-SPECIFIC CROSSMATCHES ARE NOT ASSOCIATED WITH GRAFT REJECTION OR POOR GRAFT SURVIVAL AFTER LIVER TRANSPLANTATION

Donaldson, Peter; Thomson, Linda J.; Heads, A; Underhill, James A.; Vaughan, R. W.; Rolando, Nancy; Williams, Roger

doi:10.1097/00007890-199511000-00024

Cited by 39 publications

(21 citation statements)

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“…22,23 However, in liver transplantation, IgM reactivity has been shown to affect graft outcome adversely, albeit less so than IgG reactivity. 12 Our rate of positive crossmatches is similar to those of other centers, [11][12][13][14][15][16][17][18] although the studies reported to date have used different criteria for a positive crossmatch, varying from greater than 10% cell death to 50% cell death. The preponderance of women did not quite reach significance, unlike the results in the study of Charco et al, 14 who also used 20% cell death as a positive crossmatch.…”

Section: Discussionsupporting

confidence: 77%

“…[10][11][12][13][14] However, this is not every center' s experience. [15][16][17][18] The liver transplant unit in Scotland was initiated in 1992 and, like many units, performed liver transplants without reference to cytotoxic donorspecific antibody status. We have examined the role of these antibodies in allograft rejection and graft survival.…”

confidence: 99%

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The effect of a positive T-lymphocytotoxic crossmatch on hepatic allograft survival and rejection

Bathgate¹,

McColl²,

Garden³

et al. 1998

Liver Transpl

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The influence of crossmatching in liver transplantation is still controversial, and at present, our unit does not alter management according to the result of standard lymphocytotoxicity testing. This study retrospectively assessed outcome of grafts transplanted in the presence of preformed antidonor cytotoxic antibody. One hundred twelve patients undergoing their first orthotopic liver transplantation had results available (mean follow-up: 18 months). Twelve patients had a positive crossmatch and 100 negative. The 1-year graft survival was 58% in the positive crossmatch group, compared with 81% in the negative crossmatch group (P ‫؍‬ .02). The 1-year patient survival was 83% in the positive crossmatch group compared with 90% in the negative group (P ‫؍‬ .41). Acute cellular rejection occurred in 6 of 7 (86%) grafts surviving more than 7 days in the positive crossmatch group compared with 46 of 88 (52%) grafts in the negative group (P ‫؍‬ .09). However, episodes of further acute cellular rejection requiring treatment occurred in 4 of the 6 grafts in the positive crossmatch group but in only 4 of the 46 grafts with a negative crossmatch (P ‫؍‬ .0006). The authors conclude that evidence exists in our population that preformed antidonor antibodies adversely affect the outcome of hepatic allografts but not patient survival.

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Section: Discussionsupporting

confidence: 77%

confidence: 99%

The effect of a positive T-lymphocytotoxic crossmatch on hepatic allograft survival and rejection

Bathgate¹,

McColl²,

Garden³

et al. 1998

Liver Transpl

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“…50 Several reports have found a relationship between HLA antigen matching and/or mismatching, positive lymphocytotoxic cross-matching, and the development of liver allograft CR. 30,31,[51][52][53][54][55] In this study, these factors did not predispose to the development of CR. In summary, the incidence of CR is low among patients maintained long term on tacrolimus-based therapy.…”

Section: Discussionmentioning

confidence: 41%

Does tacrolimus offer virtual freedom from chronic rejection after primary liver transplantation? Risk and prognostic factors in 1,048 liver transplantations with a mean follow-up of 6 years

Jain

Demetris

Kashyap

et al. 2001

Liver Transplantation

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Tacrolimus has proven to be a potent immunosuppressive agent in liver transplantation (LT). Its introduction has led to significantly less frequent and severe acute rejection. Little is known about the rate of chronic rejection (CR) in primary LT using tacrolimus therapy. The aim of the present study is to examine the long-term incidence of CR, risk factors, prognostic factors, and outcome after CR. The present study evaluated the development of CR in 1,048 consecutive adult primary liver allograft recipients initiated and mostly maintained on tacrolimus-based immunosuppressive therapy. They were evaluated with a mean follow-up of 77.3 ؎ 14.7 months (range, 50.7 to 100.1 months). To assess the impact of primary diagnosis on the rate and outcome of CR, the population was divided into 3 groups. Group I included patients with hepatitis C virus (HCV)-or hepatitis B virus (HBV)-induced cirrhosis (n ‫؍‬ 312); group II included patients diagnosed with primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), or autoimmune hepatitis (AIH; n ‫؍‬ 217); and group III included patients with all other diagnoses (n ‫؍‬ 519). Overall, 32 of 1,048 patients (3.1%) developed CR. This represented 13 (4.1%), 12 (5.5%), and 7 patients (1.3%) in groups I, II, and III, respectively. The relative risk for developing CR was 3.2 times greater for group I and 4.3 times greater for group II compared with group III. This difference was statistically significant (P ‫؍‬ .004). The incidence of acute rejection and total number of acute rejection episodes were significantly greater in patients who developed CR compared with those who did not (P < .0001). Similarly, the mean donor age for CR was significantly older than for patients without CR (43.0 v 36.2 years; P ‫؍‬ .02). Thirteen of the 32 patients (40.6%) who developed CR retained their original grafts for a mean period of 54 ؎ 25 months after diagnosis. Seven patients (21.9%) underwent re-LT, and 12 patients (38.3%) died. Serum bilirubin levels and the presence of arteriopathy, arterial loss, and duct loss on liver biopsy at the time of diagnosis of CR were significantly greater among the 3 groups of patients. In addition, patient and graft survival for group I were significantly worse compared with groups II and III. We conclude that CR occurred rarely among patients maintained long term on tacrolimus-based immunosuppressive therapy. When steroid use is controlled, the incidence of acute rejection, mean donor age, HBV-and/or HCV-induced cirrhosis, or a diagnosis of PBC, PSC, or AIH were found to be predictors of CR. Greater values for serum bilirubin level, duct loss, arteriopathy, arteriolar loss, and presence of HCV or HBV were found to be poor prognostic factors for the 3 groups; greater total serum bilirubin value (P ‫؍‬ .05) was the only factor found to be significant between patients who had graft loss versus those who recovered. (Liver Transpl 2001;7:623-630.)

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“…6,7 In liver transplant recipients, early studies failed to show an association between DSA and liver allograft rejection or graft survival. 8,9 However, there has recently been further discussion on the effects of a positive crossmatch and the presence of DSA on allograft function in LT, indicating an influence on graft survival. [10][11][12][13] Moreover, it is still not clear whether a more important role is played by antibodies against HLA class 1 or class 2.…”

mentioning

confidence: 99%

Long-term Clinical Relevance of De Novo Donor-Specific Antibodies After Pediatric Liver Transplantation

et al. 2015

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The prevalence of DSA was 33% for group 1 and 68% for group 2. Antibodies were predominantly HLA class II. Values of mean fluorescence intensity were comparable in both groups. Only one of the DSA+ ve patients from group 1 exhibited preformed antibodies. In conclusion, pediatric patients with chronic rejection revealed a higher rate of de novo DSA, especially of HLA-class II DSA. Further studies are necessary to confirm these data with a larger pediatric cohort.

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IgG DONOR-SPECIFIC CROSSMATCHES ARE NOT ASSOCIATED WITH GRAFT REJECTION OR POOR GRAFT SURVIVAL AFTER LIVER TRANSPLANTATION

Cited by 39 publications

References 0 publications

The effect of a positive T-lymphocytotoxic crossmatch on hepatic allograft survival and rejection

The effect of a positive T-lymphocytotoxic crossmatch on hepatic allograft survival and rejection

Does tacrolimus offer virtual freedom from chronic rejection after primary liver transplantation? Risk and prognostic factors in 1,048 liver transplantations with a mean follow-up of 6 years

Long-term Clinical Relevance of De Novo Donor-Specific Antibodies After Pediatric Liver Transplantation

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