The antibody crossmatch in liver transplantation

Abstract

Six hundred sixty-seven first, second, and third orthotopic liver allografts in 520 patients were reviewed to determine the effect of recipient panel-reactive antibody (PRA) and donor-recipient antibody crossmatch on 2-year patient and liver allograft survival rates. Neither a high panel-reactive antibody nor a positive crossmatch for donor-specific preformed antibody was associated with decreased patient or liver allograft survival for primary grafts or retransplants. Two patients have been given kidney transplants immediately after a liver allograft from a donor with whom each patient had an initial strongly positive donor-specific antibody crossmatch. The liver apparently removed or neutralized circulating anti-donor antibody, since the renal allografts functioned promptly and did not experience hyperacute rejection.

Fig. 1

A, The actuarial survival rate for 520 patients and 667 first, second, and third liver allografts. B, Actuarial graft survival rate for 517 primary grafts and 150 retransplants. The primary graft survival rate is significantly better than the survival rate for retransplanted grafts (p < 0.001).

Fig. 2

A, The actuarial survival rate for 505 grafts for which PRA data are available is compared with the survival rate for the entire series of 667 transplants. There is no significant difference. B, The actuarial survival rate for 67 grafts in patients with a PRA greater than 30%, including 39 grafts in patients with a PRA greater than 60%, compared with 438 grafts in patients with a PRA less than 30%. There are no significant differences in graft survival rates.

Fig. 3

There are no significant differences in actuarial survival rates for 417 primary grafts (A) and 88 retransplants (C) for which PRA data are available compared with all 517 primary grafts (A) and all 150 retransplants (C). There are no significant differences in graft survival rates for 48 primary grafts in patients with a PRA greater than 30% (B), including 31 grafts in patients with a PRA greater than 60%, compared with 369 primary grafts in patients with a PRA under 30% (B) or for survival of 51 retransplants with a PRA greater than 30% (D), including eight retransplants in patients with a PRA greater than 60%, compared with 69 retransplants in patients with a PRA less than 30% (D).

Fig. 4

A, The actuarial survival rate for 433 grafts for which antibody crossmatch data are available compared with the survival rate for the entire series of 667 transplants. There is no significant difference. B, Actuarial survival for 62 grafts in patients with a positive crossmatch compared with 371 grafts in patients with a negative crossmatch. There are no significant differences in graft survival rates.

Fig. 5

There are no significant differences in actuarial survival rates for 337 primary grafts (A) and 96 retransplants (C) for which crossmatch data are available compared with all 517 primary grafts (A) and all 150 retransplants (C). There are no significant differences in graft survival rates for 38 primary grafts in patients with a positive crossmatch (B) compared with 299 primary grafts in patients with a negative crossmatch (B) or for survival of 24 retransplants with a positive crossmatch (D) compared with 72 retransplants in patients with a negative crossmatch (D).

Fig. 6

A, The actuarial survival rate for 382 grafts for which both antibody crossmatch and PRA data are available is compared with survival rate for the entire series of 667 transplants. There is no significant difference. B, The actuarial survival rate for 282 grafts in patients with a positive crossmatch and a PRA greater than 30% (including 20 patients with a PRA more than 60%) is compared with survival rate for 305 grafts in patients with a negative crossmatch and PRA less than 30%. There are no significant differences in graft survival rates.

Fig. 7

A 43-year-old woman with chronic liver and renal failure from end-stage primary biliary cirrhosis received a liver transplant from a cadaver donor with whom she had a positive antibody crossmatch. A kidney was implanted from the same donor immediately after completion of the liver transplant. The postoperative course, including immunosuppression with cyclosporine and prednisone, renal function, and liver function, is shown. Hyperacute rejection of either graft did not occur and both grafts continue to function well 18 months after transplantation.