title: Significance of true-positive and false-positive pretransplantation lymphocytotoxic crossmatch in primary liver allograft outcomes.
abstract: BACKGROUND
  At the time of transplantation, a recipient's serum is tested against the prospective donor's lymphocytes to identify specific reactivity and to look for a donor-specific crossmatch (CXM). Here, we investigated the relationship between the pretransplantation lymphocytotoxic CXM results and the long-term outcome of liver transplantation at a single center.
  
  
  METHODS
  From October 1998 to April 2011, medical records, laboratory data, and pretransplantation lymphocytotoxic CXM results were collected from 1133 consecutive liver transplant recipients.
  
  
  RESULTS
  We performed liver transplantations on 80 (7.1%) patients after a true-positive CXM (t+CXM). The t+CXM group exhibited higher initial aminotransferase levels immediately after transplantation compared with a negative CXM group. However, no significant differences in rejection, biliary or vascular complications, viral disease recurrence, or de novo malignancies were found. Although overall graft and patient survival did not differ between the groups, liver-specific graft survival was inferior in the t+CXM group. It was also found that, in 42 (3.7%) recipients, initially positive results converted to final negative results after the elimination of immunoglobulin M autoantibodies. We defined this subpopulation as a false-positive CXM. Significantly decreased posttransplantation aminotransferase levels with a higher incidence of de novo malignancies were observed in this group compared with negative controls.
  
  
  CONCLUSIONS
  Our findings demonstrate that t+CXM transplants show increased aspartate aminotransferase and alanine aminotransferase peak immediately after transplantation, which influences liver-specific graft outcomes. Additionally, the presence of circulating immunoglobulin M autoantibodies against recipients' own antigens may be protective in liver grafts. However, this may be a predisposing factor for de novo malignancies.
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Milljae
authors.initials: M
authors.lastname: Shin
authors.forename: Hyung Hwan
authors.initials: HH
authors.lastname: Moon
authors.forename: Jong Man
authors.initials: JM
authors.lastname: Kim
authors.forename: Jae Berm
authors.initials: JB
authors.lastname: Park
authors.forename: Choon Hyuck David
authors.initials: CH
authors.lastname: Kwon
authors.forename: Sung-Joo
authors.initials: SJ
authors.lastname: Kim
authors.forename: Suk-Koo
authors.initials: SK
authors.lastname: Lee
authors.forename: Jae-Won
authors.initials: JW
authors.lastname: Joh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000961:Antilymphocyte Serum / Q000097:blood*; D001788:Blood Grouping and Crossmatching; D002648:Child; D002675:Child, Preschool; D005189:False Positive Reactions; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival / Q000276:immunology / Q000502:physiology; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D015994:Incidence; D007223:Infant; D016031:Liver Transplantation / Q000276:immunology* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D012189:Retrospective Studies; D000637:Transaminases / Q000097:blood; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000961:Antilymphocyte Serum; D007075:Immunoglobulin M; D000637:Transaminases