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

• 堀, 智英

• Uemoto, Shinji

• Takada, Yasutsugu

• Oike, Fumitaka

• Ogura, Yasuhiro

• Ogawa, Kohei

• Miyagawa-Hayashino, Aya

• Yurugi, Kimiko

• Nguyen, Justin H

• Hori, Yukinobu

• Chen, Feng

• Egawa, Hiroto

抄録

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.

収録刊行物

• Surgery

  Surgery 147 (6), 840-844, 2010-06

  Elsevier

詳細情報

• CRID: 1050001202064920064
• NII論文ID: 120002191871
• NII書誌ID: AA00853880
• ISSN: 15327361
• HANDLE: 2433/120345
• 本文言語コード: en
• 資料種別: journal article
• データソース種別:
  • IRDB
  • CiNii Articles