Positive crossmatch with persistent donor specific antibodies increases risk of rejection in liver transplantation: A retrospective single-center analysis

Abstract

Evidence is mixed regarding the effect of positive crossmatch (XM) and preformed donor-specific antibodies (DSA) on rejection in liver transplant recipients. We categorized liver transplant recipients by XM and DSA status (XM negative, XM positive with resolved DSA, and XM positive with persistent DSA or any de novo DSA) and examined biopsy-proven rejection incidence within 6 months post-transplant, DSA trends, and immunosuppression management. Of 273 liver transplant recipients, 237 (86.8 %) were XM negative and 36 (13.2 %) were XM-positive, of whom 13 (36.1 %) had persistent or de novo DSA and 23 (63.8 %) had resolved DSA. Recipients in the persistent DSA group experienced earlier rejection at a higher rate (69.2 % at median of 25 days post-transplant) compared to the other two groups (21.7 % at median of 31 days in the resolved DSA group and 19.4 % at median of 46 days in the XM negative group; p < 0.001). Recipients in the persistent DSA group were also more likely to experience multiple rejection events (p < 0.001). XM positive recipients with persistent DSA or de novo DSA are at higher risk for early allograft rejection, while those who can clear their DSA early have a rejection risk profile similar to recipients with a negative crossmatch.