The adverse impact on liver transplantation of using positive cytotoxic crossmatch donors.
Because of the liver graft's ability to resist cytotoxic antibody-mediated rejection, it has become dogma that the conventional transplant crossmatch used to avoid hyperacute rejection of other organs is irrelevant to the liver. We examined this hypothesis in a consecutive series of adult primary liver recipients treated with FK506 and low-dose steroids. Twenty-five of 231 (10.8%) patients received a liver from a cytotoxic-positive crossmatch donor (more than 50% of donor T lymphocytes were killed by dithiothreitol-pretreated recipient serum). The outcome was compared with that of 50 negative crossmatch patients who had their transplantations just before and after the crossmatch positive cases. The one-year graft and patient survivals were 56% and 68%, for positive and 82% and 86% for negative crossmatch patients (P = 0.004, P = 0.03, respectively). The difference between patient and first graft survival was accounted for by retransplantation, which was 4 times more frequent in the positive-crossmatch cases. Histologically, failed allografts obtained at the time of retransplantation revealed a spectrum of pathologic findings related to vascular injury. This study showed a higher difficulty of intraoperative blood product management, a degraded prognosis, and a poorer average quality of ultimate graft function when liver transplantation was performed against positive cytotoxic crossmatches. In such patients for whom crossmatch-negative donors may never be found because of the broad extent and intensity of sensitization, special therapeutic strategies perioperatively must be evolved if results are to improve.
Takaya
S
S
Department of Surgery, Pittsburgh Transplant Institute, University of Pittsburgh School of Medicine, Pennsylvania.
Bronsther
O
O
Iwaki
Y
Y
Nakamura
K
K
Abu-Elmagd
K
K
Yagihashi
A
A
Demetris
A J
AJ
Kobayashi
M
M
Todo
S
S
Tzakis
A G
AG
D000328:Adult; D000920:Antibody-Dependent Cell Cytotoxicity; D000937:Antigen-Antibody Reactions; D001788:Blood Grouping and Crossmatching; D001803:Blood Transfusion; D004229:Dithiothreitol / Q000627:therapeutic use; D005260:Female; D006084:Graft Rejection / Q000187:drug effects; D006085:Graft Survival; D006801:Humans; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000009:adverse effects* / Q000276:immunology*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D016559:Tacrolimus / Q000627:therapeutic use
D004229:Dithiothreitol; D016559:Tacrolimus; D008775:Methylprednisolone