A POSITIVE CROSS-MATCH IN LIVER-TRANSPLANTATION - NO EFFECT OR INAPPROPRIATE ANALYSIS - A PROSPECTIVE-STUDY

Background. Controversy over the relationship of preformed lymphocytot oxic antibodies and liver graft outcome remains. Because graft loss as sociated with preformed lymphocytotoxic antibodies probably occurs ear ly after transplant, analysis of long-term survival is of questionable value. We therefore prospectively analyzed the effect on short- and l ong-term graft survival of the presence of lymphocytotoxic alloantibod y in 207 primary adult liver allograft recipients. Methods. Pretranspl ant serum was tested for donor-specific lymphocytotoxic antibodies and panel-reactive antibodies (PRA) using donor splenic lymphocytes and l ymphocytes obtained for routine tissue typing. Results. A positive cro ssmatch was detected in 24 recipients (11.5%): T-cell positive in 11 r ecipients and B-cell positive in 13 recipients. PRA were detected in 6 8 of 179 recipients tested (37.4%). High T-cell PRA (>55%) was detecte d in 17 recipients, and high B-cell PRA was detected in 20 recipients. Low PRA (<15%) against T cells was detected in 19 recipients and agai nst B cells in 24 recipients. Graft failures occurred in 5 of 24 (21%) crossmatch-positive recipients and in 7 of 172 (4%) crossmatch-negati ve recipients. Graft survival was significantly lower in crossmatch-po sitive recipients at 1 month after transplant (chi-square=10.3, P=0.00 133) but not at 3 months or 1 year. Causes of early graft loss were as sociated with immunological mechanisms, whereas later losses were due to nonimmunological mechanisms. Conclusions. Early graft loss may be i ncreased in those recipients who are crossmatch positive. However, the logistical problems and consequences associated with allocation proba bly outweigh the benefits of prospective crossmatching.