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Liver transplantation with a strongly positive crossmatch: Case study and literature review
Author(s) -
Leonard Garrett R.,
Shike Hiroko,
Uemura Tadahiro,
Gaspari Justine L.,
Ruggiero Francesca M.,
Shah Riaz A.,
Riley Thomas R.,
Kadry Zakiyah
Publication year - 2013
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.23694
Subject(s) - medicine , liver transplantation , transplantation , donor specific antibodies , complement dependent cytotoxicity , cholestasis , flow cytometry , gastroenterology , antibody , immunology , urology , kidney transplantation , monoclonal antibody , antibody dependent cell mediated cytotoxicity
A positive crossmatch has been associated with increased risk in liver transplantation. To study the clinical significance of preformed donor‐specific human leukocyte antigen antibodies (DSAs) in liver transplantation, we reviewed patients who underwent liver transplantation with a strongly positive flow cytometry crossmatch. DSAs were evaluated with a Luminex solid phase assay. The complement‐fixing ability of DSAs was tested with a complement component 1q (C1q) assay. Using an assay correlation between complement‐dependent cytotoxicity crossmatch, flow cytometry crossmatch, and DSA results, we reviewed the effects of DSAs on the outcomes of our patients as well as reported cases in the literature. Five of 69 liver recipients had a strongly positive crossmatch: 4 had a positive T cell crossmatch [median channel shift (MCS) = 383.5 ± 38.9], and 5 had a positive B cell crossmatch (MCS = 408.8 ± 52.3). The DSAs were class I only in 1 patient, class I and II in 3 patients, and class II only in 1 patient. Cholestasis, acute rejection, or both were observed in 3 of the 4 patients with a positive T cell crossmatch with an MCS approximately greater than 300. The C1q assay was positive for 3 patients. Two had either persistent cholestasis or early acute rejection. One patient who was treated with preemptive intravenous immunoglobulin had an unremarkable outcome despite a positive C1q result. One of the 2 patients with a negative C1q assay experienced persistent cholestasis and early and recurrent acute rejection; the other had an unremarkable outcome. None of the patients died or lost a graft within the first year of transplantation. Our study suggests that human leukocyte antigen antibody screening, flow cytometry crossmatch MCS levels, DSA mean fluorescent intensity levels, and C1q assays may be useful in assessing the risk of antibody‐mediated rejection and timely interventions in liver transplantation. Liver Transpl 19:1001–1010, 2013 . © 2013 AASLD.