Does a positive lymphocyte cross-match contraindicate living-donor liver transplantation?
BACKGROUND
There is still no consensus on the importance of lymphocyte cross-matching (LCM) in the field of living-donor liver transplantation (LDLT).


METHODS
LCM examinations are routinely performed before LDLT, and the results of complement-dependent cytotoxicity were used in this study. A total of 1157 LDLT cases were evaluated. The recipients were divided into four groups based on the LCM and ABO compatibilities: (1) negative LCM and identical/compatible ABO; (2) negative LCM and incompatible ABO; (3) positive LCM and identical/compatible ABO; and (4) positive LCM and incompatible ABO. The diagnosis of antibody-mediated rejection (AMR) was made based on the clinical course, immunological assays and histopathological findings. C4d immunostaining was added if AMR was suspected.


RESULTS
The LCM-positive LDLT recipients showed significantly poorer outcomes than the LCM-negative recipients. Among the LCM-positive recipients, 44.1% of recipients eventually died and 85.2% of recipients revealed positive C4d findings. The survival rate of LCM-positive and ABO-incompatible group was 0.50. The survival days were compared with the LCM-negative and ABO-identical/compatible group, and the LCM-positive and ABO-identical/compatible group clearly showed early death after LDLT, although the ABO-incompatible groups did not show significant. The factors of age, disease, pre-transplant scores, LCM, ABO compatibility and graft-recipient weight ratio showed statistical significance in multivariate analysis for important factors of LDLT outcomes. However, the LCM and ABO compatibilities had no synergetic effects on the LDLT survival.


CONCLUSIONS
HLA antigens are more widely expressed than ABO antigens, and advanced immunological strategies must be established for LCM-positive LDLT as well as for ABO-incompatible LDLT.
Hori
Tomohide
T
Department of Transplant Surgery, Kyoto University Hospital, Kyoto, Japan. horit@kuhp.kyoto-u.ac.jp
Uemoto
Shinji
S
Takada
Yasutsugu
Y
Oike
Fumitaka
F
Ogura
Yasuhiro
Y
Ogawa
Kohei
K
Miyagawa-Hayashino
Aya
A
Yurugi
Kimiko
K
Nguyen
Justin H
JH
Hori
Yukinobu
Y
Chen
Feng
F
Egawa
Hiroto
H
D000017:ABO Blood-Group System / Q000276:immunology*; D001787:Blood Group Incompatibility / Q000276:immunology; D001788:Blood Grouping and Crossmatching / Q000379:methods*; D000075202:Contraindications; D006680:HLA Antigens / Q000276:immunology; D006650:Histocompatibility Testing / Q000379:methods; D006801:Humans; D016031:Liver Transplantation / Q000276:immunology* / Q000401:mortality; D019520:Living Donors; D017710:Lymphocyte Transfusion; D008214:Lymphocytes / Q000276:immunology*; D016019:Survival Analysis; D015996:Survival Rate
D000017:ABO Blood-Group System; D006680:HLA Antigens