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

Abstract

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.

Positive T lymphocytotoxic cross-match in living donor liver transplantation

“…12 In brief, the recipient serum obtained immediately before LDLT was tested for cytotoxic antibody against donor T or B lymphocytes. Donor lymphocytes were isolated from peripheral blood, and 1 L of the patient's serum was added for 30 minutes at room temperature.…”

“…In contrast, Takaya et al 10 showed that highly sensitized cross-match-positive grafts had a poor prognosis and function in tacrolimus-based immunosuppression. Other reports indicated the higher incidence of vanishing bile duct syndrome 11 or the severity of the acute rejection episodes 12,13 in crossmatch-positive grafts. Some similar reports have proposed adverse effects of the positive results on patient or graft survival.…”

Positive Lymphocytotoxic Crossmatch Does Not Adversely Affect Survival in Living Donor Liver Transplantation

“…Other reports indicated a higher incidence of vanishing bile duct syndrome [12], and more severe acute rejection episodes [13,14] or acute rejection within 3 months after transplantation [15] in cases with crossmatch-positive grafts. The adverse effects of a positive crossmatch on patient and graft survival are also emphasized in other reports [4,5,16,17,18,19,20,21], but the rate of hyperacute rejection or the causal association between graft loss and acute rejection is not clear.…”

Significance of positive cytotoxic cross-match in adult-to-adult living donor liver transplantation using small graft volume

“…However, effects of positive cross-match in liver transplantation remain controversial, although a number of recent studies suggested that these antibodies might increase the risk for both rejection and early graft failure in liver transplantation. [3][4][5][6][7] Recent studies have provided pathological confirmation that immunoglobulin G lymphocytotoxic antibodies could adversely affect the human liver allograft. 8 Conversely, human liver transplants classically have been reported to be resistant to antibody-mediated rejection, and transplantation has been performed successfully with positive antidonor cross-matches, established by the standard microlymphocytotoxicity test.…”

“…1,2 More recent results from other studies contradicted these findings, showing a greater rejection rate and worse graft survival in patients who had a positive crossmatch. [3][4][5][6][7] Recently, living donor liver transplantation (LDLT) is performed increasingly because of a shortage of cadaveric donors. Adult-to-adult LDLT is limited by the need to transplant sufficient liver mass while preserving donor safety.…”