Significance of positive cytotoxic cross-match in adult-to-adult living donor liver transplantation using small graft volume.
A positive cross-match in cadaveric liver transplantation is relatively acceptable, but its role in living donor liver transplantation (LDLT) is less well known. The aim of this study is to examine the significance of cytotoxic cross-match in adult-to-adult LDLT using small-for-size grafts. Forty-three adult-to-adult LDLTs were performed at Seoul National University Hospital (Seoul, Korea) from January 1999 to July 2001. Subjects consisted of 27 men and 16 women with an average age of 45.4 years. Average liver graft weight was 565.3 +/- 145.7 g, and average graft-recipient weight ratio (GRWR) was 0.89% +/- 0.20%. HLA cross-match testing by lymphocytotoxicity and flow cytometry was performed routinely preoperatively. Factors that may influence survival, such as age; sex; blood group type A, type B, type O compatibility; cytotoxic cross-match; donor age; surgical time; cold ischemic time; and GRWR, were analyzed. Nine patients (20.9%) died in the hospital. There was a greater in-hospital mortality rate in women than men (37.5% v 11.1%; P = .049). The extra-small-graft group (0.54% < or = GRWR < 0.8%; n = 14) showed greater in-hospital mortality rates than the small-graft group (0.8% < or = GRWR < or = 1.42%; n = 29; 42.9% v 10.3%; P = .022). A positive cross-match was detected in 4 women transplant recipients, and 3 of these patients belonged to the extra-small-graft group. All patients with a positive cross-match died of multiorgan failure after early postoperative acute rejection episodes. Positive cross-match was the only significant factor in multivariate analysis (P = .035). In conclusion, when lymphocytotoxic cross-match and flow cytometry are significantly positive, adult-to-adult LDLT using small-for-size grafts should not be performed.
Suh
Kyung-Suk
KS
Department of Surgery, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital, Seoul, Korea. kksuh@plaza.snu.ac.kr
Kim
Sang Beom
SB
Chang
Seong-Hwan
SH
Kim
Seong Hoon
SH
Minn
Kyung Won
KW
Park
Myoung Hee
MH
Han
Kyou Sup
KS
Lee
Kuhn Uk
KU
D000017:ABO Blood-Group System; D000328:Adult; D001402:B-Lymphocytes / Q000276:immunology; D003602:Cytotoxicity, Immunologic; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006509:Hepatitis B / Q000601:surgery; D006650:Histocompatibility Testing; D006801:Humans; D016031:Liver Transplantation / Q000276:immunology* / Q000379:methods / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D013601:T-Lymphocytes / Q000276:immunology; D013997:Time Factors
D000017:ABO Blood-Group System