Impact of Positive Lymphocyte Cross-match Test on Livingdonor Liver Transplant

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［Introduction］ In liver transplant, antibody mediated rejection is believed to occur less frequently and to lead less graft losses than in kidney transplant. So, liver transplant has been performed irrespective of positive lymphocyte crossmatch test. Nowadays, even in kidney transplant, both ABO incompatibility and cross-match positivity are being overcome with plasmapheresis, intravenous immunoglobulin, and improvement of immunosuppressive agents such as rituximab and IL-2 receptor antagonists. Retrospective analysis on living donor liver transplant recipient was performed focusing on cross-match positivity and posttransplant complications. ［Patients and methods］ Since 1994, 41 living-donor liver transplants were performed. Retrospective analysis was done in 33 patients, who were done pretransplant cross-match test. Immunosuppression was basically initiated with steroid and tacrolimus. ［Results］ Twelve patients （36.3%） were positive for lymphocyte cross-match. Acute rejection occurred in 13 cases（33.3％） within 180 post transplant days. One-year rejection-free survival were 42.3% in positive cases and 72.2% in negative cases （p<0.05）, but there was no significance in patient survival. Posttransplant complications including biliary stenosis, hepatic vein stenosis, and portal vein stenosis occurred more frequently in positive lymphocyte crossmatch transplant patietns（p<0.05）. ［Conclusion］ With improvement of immunosuppressive agents, liver transplant can be successfully performed with more favorable survival even in cross-match positive pair. Complications, however, happen more frequently in those recipients compared to cross-match negative ones. Posttransplant course should be carefully followed focusing on biliary and vascular complications. Screening of donor specific antigen by FACS cross-match test and LABScreen® would give us new information and strategy.

弘前医学. 64(Suppl.), 2013, p.S107-S112

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  • 弘前医学

    弘前医学 64 (Supplement), S107-S112, 2013-04-02

    弘前大学大学院医学研究科・弘前医学会

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