The impact of a positive crossmatch upon outcome after liver transplantation

Recent reports have shown that liver allografts transplanted against a positive lymphocytotoxic crossmatch (CDC+) are susceptible to an increased frequency of rejection, and decreases in patient and graft survival. The implication of a positive flow cytometric crossmatch (FCXM+) in liver transplanta...

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Bibliographic Details
Published in:	Transplantation Vol. 62; no. 12; pp. 1794 - 1798
Main Authors:	GOGGINS, W. C, FISHER, R. A, POSNER, M. P, KIMBALL, P. M, WOLFE, L, HILL, B. E, PIETRUSZKA, T. D, SHIFFMAN, M. L, SANYAL, A. J, LUKETIC, V. A. C, HAM, J. M
Format:	Conference Proceeding Journal Article
Language:	English
Published:	Hagerstown, MD Lippincott 27-12-1996
Subjects:	Adult Biological and medical sciences Blood Grouping and Crossmatching - methods Female Flow Cytometry Graft Rejection - prevention & control Graft Survival - physiology Humans Liver Transplantation - immunology Liver, biliary tract, pancreas, portal circulation, spleen Male Medical sciences Middle Aged Muromonab-CD3 - therapeutic use Prospective Studies Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the digestive system T-Lymphocytes, Cytotoxic - pathology Human Incompatibility HLA-System Prognosis Surgery Liver Transplantation Homotransplantation
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Summary:	Recent reports have shown that liver allografts transplanted against a positive lymphocytotoxic crossmatch (CDC+) are susceptible to an increased frequency of rejection, and decreases in patient and graft survival. The implication of a positive flow cytometric crossmatch (FCXM+) in liver transplantation remains controversial. The purpose of this study was to determine what impact a pretransplant IgG crossmatch due to CDC+ or FCXM+ had upon the clinical outcome following liver transplantation. Preoperative crossmatch status was determined prospectively in 110 consecutive liver transplants performed between July 1991 and January 1995. Allografts were divided into three groups: negative crossmatch (NXM), positive flow cytometric crossmatch FCXM+, and positive lymphocytotoxic crossmatch CDC+. Crossmatch status did not impact patient or graft survival. Actuarial patient survival was similar between groups at 12 months (88% vs. 95% vs. 92%, NXM vs. FCXM+ vs. CDC+) and 24 months (81% vs. 93% vs. 92%, NXM vs. FCXM+ vs. CDC+) (P=0.1938). Actuarial allograft survival was similar between groups at 12 months (76% vs. 93% vs. 85%, NXM vs. FCXM+ vs. CDC+) and 24 months (76% vs. 89% vs. 85%, NXM vs. FCXM+ vs. CDC+) (P=0.0738). CDC+ allografts had a significant increase in early rejection episodes compared with NXM (46% vs. 7%, CDC+ vs. NXM) (P=0.003) or FCXM+ allografts (46% vs. 10%, CDC+ vs. FCXM+) (P=0.006). CDC+ allografts experienced significantly more rejection episodes per year than NXM (53% vs. 20%, CDC+ vs. NXM) (P=0.015) or FCXM+ allografts (53% vs. 23%, CDC+ vs. FCXM+) (P=0.02). CDC+ allografts had a significant increase in numbers of additional nonconventional therapeutic interventions compared to NXM allografts (0.9+/-0.5 vs. 0.2+/-0.1, CDC+ vs. NXM) (P=0.039). The presence of cytotoxic antibodies pretransplantation is associated with increased incidences of early rejection, and rejection episodes per year. With careful monitoring and aggressive therapeutic interventions the presence of cytotoxic antibodies are not deleterious to patient or liver allograft survival.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Article-1 ObjectType-Feature-2
ISSN:	0041-1337 1534-6080
DOI:	10.1097/00007890-199612270-00019