Does a positive lymphocyte cross-match contraindicate living-donor liver transplantation?

Tomohide Hori, Shinji Uemoto, Yasutsugu Takada, Fumitaka Oike, Yasuhiro Ogura, Kohei Ogawa, Aya Miyagawa-Hayashino, Kimiko Yurugi, Justin H. Nguyen, Yukinobu Hori, Feng Chen, Hiroto Egawa

Research output: Contribution to journalArticle

35 Scopus citations

Abstract

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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)840-844
Number of pages5
JournalSurgery
Volume147
Issue number6
DOIs
StatePublished - Jun 1 2010

ASJC Scopus subject areas

  • Surgery

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    Hori, T., Uemoto, S., Takada, Y., Oike, F., Ogura, Y., Ogawa, K., Miyagawa-Hayashino, A., Yurugi, K., Nguyen, J. H., Hori, Y., Chen, F., & Egawa, H. (2010). Does a positive lymphocyte cross-match contraindicate living-donor liver transplantation? Surgery, 147(6), 840-844. https://doi.org/10.1016/j.surg.2009.11.022