Increased late hepatic artery thrombosis rate and decreased graft survivalafter liver transplants with zero cross-reactive group mismatches

The use of broad-specificity cross-reactive groups (CREGs) at the A and B H LA loci has been proposed as a means to improve both access and outcome for renal transplantation but has not yet been studied for liver transplantati on. We retrospectively analyzed our results for all adult liver transplanta tions performed at our center between 1989 and 1996 for which HLA typing an d complete S-year follow-up data were available. Two hundred eight transpla ntations were studied, with a mean follow-up of 66 +/- 2 months (range, 36 to 110 months); A and B loci were converted to CREGs by the method of Rodey . Thirteen percent of the patients with 0 CREG mismatches had hepatic arter y thrombosis versus 2% for those with 1 or more mismatches (odds ratio, 6.7 ; 95% confidence interval, 2.6 to 17.3 by univariate analysis; odds ratio, 3.5; 95% confidence interval, 1.1 to 11.7 by logistic regression analysis). These events occurred significantly later in the 0-CREG mismatch group (21 +/- 7 v 4 +/- 2 months posttransplantation; P = .04 by Student's t-test). Graft survival rates were significantly Lower for patients with 0 CREG mism atches (56% v 68% at end of study; P = .05 by Cox-Mantel test). The number of CREG mismatches had no effect on the frequency of rejection, steroid-res istant rejection, or infectious complications, including cytomegalovirus. N either total nor individual A, B, or DR HLA matching had an effect on outco me. There appears to be little evidence that intentional CREG matching woul d improve outcomes for liver transplantation and, under some circumstances, could be deleterious. Copyright (C) 2000 by the American Association for t he Study of Liver Diseases.