POSITIVE PRETRANSPLANT CROSS-MATCHES PREDICT EARLY GRAFT LOSS IN LIVER ALLOGRAFT RECIPIENTS

We evaluated the influence of donor-recipient HLA compatibility and re cipient pretransplant antidonor sensitization on liver allograft recip ient survival. The overall graft survival results for 67 cyclosporine- prednisone treated liver allograft recipients at 3, 6, and 12 months p osttransplant were 86%, 83%, and 83%, respectively. No significant dif ferences were observed when comparing the one-year survivals of 81% vs . 85% for men and women or 80% vs. 85% for adult and pediatric patient s. Similarly, no differences were observed when comparing one-year gra ft survivals for well vs. poorly matched recipients of 77% vs. 83% for recipients with less than or equal to 2 HLA A, B vs. >2 HLA A, B mism atches (MMs) and 82% vs. 82% for recipients with 0-1 HLA-DR MMs vs. 2 HLA-DR MMs, respectively. Pretransplant transfusion history and race a lso did not influence survival. Standard NIH (long-incubation) and ant i-human globulin (AHG) crossmatches were performed. The 12% of recipie nts (8/67) displaying a positive NIH crossmatch experienced significan tly poorer 3-, 6-, and 12-month survivals of 62% vs. 89%, 62% vs. 86%, and 62% vs. 86% (all P<0.05), respectively, than the 59 NIH-crossmatc h negative recipients. Similarly, the 16% (11/67) of recipients displa ying a positive AHG crossmatch had significantly poorer 3-, 6-, and la -month survivals of 63% vs. 91%, 54% vs. 89%, and 54% vs. 89% (all P<0 .05) respectively, than the 56 AHG crossmatch-negative recipients. NIH and AHG crossmatch-positive sera were treated with dithioerythritol ( DTE) to establish whether reactivity was due to IgM or IgG immunoglobu lin. One-year graft survivals of 65% vs. 30% (P<0.05) were observed wh en the crossmatch-positive sera reactivities were due to IgM vs. IgG i mmunoglobulin. While graft survivals were improved when positive cross match serum reactivity was due to IgM, these survivals were still sign ificantly poorer than when the crossmatches were completely negative ( 86% vs. 60%, P<0.05 for NIH-negative vs. NIH-positive, but DTE-negativ e, and 88% vs. 77%, P<0.05 for AHG-negative vs. AHG-positive, but DTE- negative). Therefore, an NIH- or AHG-positive crossmatch, due either t o IgM or IgG reactivity, results in poor early (3- and 6-months) liver allograft survival. Crossmatch-positive recipients experienced signif icantly (P<0.05) more rejections and more steroid-resistant rejections (P<0.05) than crossmatch-negative recipients. Of great interest was t he fact that 55% (6/11) of recipients displaying a positive pretranspl ant crossmatch experienced a moderate initial rejection episode compar ed with only 9% (5/56) for crossmatch-negative recipients (P<0.05). Th ese results suggest, therefore, that a positive crossmatch adversely a ffects the early (3- and 6-month) survival of primary liver allografts . Since a crossmatch often cannot be performed prior to the transplant operation, the clinician's knowledge of the crossmatch results could be of importance in the choice of immunosuppressive therapy for crossm atch-positive recipients during the early posttransplant period.