THE IMPACT OF A POSITIVE CROSS-MATCH UPON OUTCOME AFTER LIVER-TRANSPLANTATION

Recent reports have shown that liver allografts transplanted against a positive lymphocytotoxic crossmatch (CDC+) are susceptible to an incr eased frequency of rejection, and decreases in patient and graft survi val, 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 trans plantation. Preoperative crossmatch status was determined prospectivel y in 110 consecutive liver transplants performed between July 1991 and January 1995, Allografts were divided into three groups: negative cro ssmatch (NXM), positive flow cytometric crossmatch FCXM(+), and positi ve lymphocytotoxic crossmatch CDC+, Crossmatch status did not impact p atient or graft survival, Actuarial patient survival was similar betwe en 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=0.193 8). Actuarial allograft survival was similar between groups at 12 mont hs (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 signif icantly more rejection episodes per year than NXM (53% vs. 20%, CDC+ v s. 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 a dditional nonconventional therapeutic interventions compared to NXM al lografts (0.9+/-0.5 vs. 0.2+/-0.1, CDC+ vs. NXM) (P=0.039). The presen ce of cytotoxic antibodies pretransplantation is associated with incre ased incidences of early rejection, and rejection episodes per year, W ith careful monitoring and aggressive therapeutic interventions the pr esence of cytotoxic antibodies are not deleterious to patient or liver allograft survival.