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

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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 2010

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Living Donors
Liver Transplantation
Lymphocytes
Transplants
Antibodies
Age Factors
HLA Antigens

ASJC Scopus subject areas

  • Surgery

Cite this

Hori, T., Uemoto, S., Takada, Y., Oike, F., Ogura, Y., Ogawa, K., ... 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

Does a positive lymphocyte cross-match contraindicate living-donor liver transplantation? / Hori, Tomohide; Uemoto, Shinji; Takada, Yasutsugu; Oike, Fumitaka; Ogura, Yasuhiro; Ogawa, Kohei; Miyagawa-Hayashino, Aya; Yurugi, Kimiko; Nguyen, Justin H; Hori, Yukinobu; Chen, Feng; Egawa, Hiroto.

In: Surgery, Vol. 147, No. 6, 06.2010, p. 840-844.

Research output: Contribution to journalArticle

Hori, T, Uemoto, S, Takada, Y, Oike, F, Ogura, Y, Ogawa, K, Miyagawa-Hayashino, A, Yurugi, K, Nguyen, JH, Hori, Y, Chen, F & Egawa, H 2010, 'Does a positive lymphocyte cross-match contraindicate living-donor liver transplantation?', Surgery, vol. 147, no. 6, pp. 840-844. https://doi.org/10.1016/j.surg.2009.11.022
Hori, Tomohide ; Uemoto, Shinji ; Takada, Yasutsugu ; Oike, Fumitaka ; Ogura, Yasuhiro ; Ogawa, Kohei ; Miyagawa-Hayashino, Aya ; Yurugi, Kimiko ; Nguyen, Justin H ; Hori, Yukinobu ; Chen, Feng ; Egawa, Hiroto. / Does a positive lymphocyte cross-match contraindicate living-donor liver transplantation?. In: Surgery. 2010 ; Vol. 147, No. 6. pp. 840-844.
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title = "Does a positive lymphocyte cross-match contraindicate living-donor liver transplantation?",
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.",
author = "Tomohide Hori and Shinji Uemoto and Yasutsugu Takada and Fumitaka Oike and Yasuhiro Ogura and Kohei Ogawa and Aya Miyagawa-Hayashino and Kimiko Yurugi and Nguyen, {Justin H} and Yukinobu Hori and Feng Chen and Hiroto Egawa",
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T1 - Does a positive lymphocyte cross-match contraindicate living-donor liver transplantation?

AU - Hori, Tomohide

AU - Uemoto, Shinji

AU - Takada, Yasutsugu

AU - Oike, Fumitaka

AU - Ogura, Yasuhiro

AU - Ogawa, Kohei

AU - Miyagawa-Hayashino, Aya

AU - Yurugi, Kimiko

AU - Nguyen, Justin H

AU - Hori, Yukinobu

AU - Chen, Feng

AU - Egawa, Hiroto

PY - 2010/6

Y1 - 2010/6

N2 - 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.

AB - 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.

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