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The adverse impact on liver transplantation of using positive cytotoxic crossmatch donors

Takaya, S and Bronsther, O and Iwaki, Y and Nakamura, K and Abu-Elmagd, K and Yagihashi, A and Demetris, AJ and Kobayashi, M and Todo, S and Tzakis, AG and Fung, JJ and Starzl, TE (1992) The adverse impact on liver transplantation of using positive cytotoxic crossmatch donors. Transplantation, 53 (2). 400 - 406. ISSN 0041-1337

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Abstract

Because of the liver graft's ability to resist cytotoxic antibody-mediated rejection, it has become dogma that the conventional transplant crossmatch used to avoid hyperacute rejection of other organs is irrelevant to the liver. We examined this hypothesis in a consecutive series of adult primary liver recipients treated with FK506 and low-dose steroids. Twenty-five of 231 (10.8%) patients received a liver from a cytotoxic-positive crossmatch donor (more than 50% of donor T lymphocytes were killed by dithiothre-itol-pretreated recipient serum). The outcome was compared with that of 50 negative crossmatch patients who had their transplantations just before and after the crossmatch positive cases. The one-year graft and patient survivals were 56% and 68%, for positive and 82% and 86% for negative crossmatch patients (P=0.004, P=0.03, respectively). The difference between patient and first graft survival was accounted for by retransplantation, which was 4 times more frequent in the positive-crossmatch cases. Histologically, failed allografts obtained at the time of retransplantation revealed a spectrum of pathologic findings related to vascular injury. This study showed a higher difficulty of intraoperative blood product management, a degraded prognosis, and a poorer average quality of ultimate graft function when liver transplantation was performed against positive cytotoxic crossmatches. In such patients for whom crossmatch-negative donors may never be found because of the broad extent and intensity of sensitization, special therapeutic strategies perioperatively must be evolved if results are to improve. © 1992 by Williams and Wilkins.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Takaya, S
Bronsther, O
Iwaki, Y
Nakamura, K
Abu-Elmagd, K
Yagihashi, A
Demetris, AJ
Kobayashi, M
Todo, S
Tzakis, AG
Fung, JJ
Starzl, TEtes11@pitt.eduTES11
Centers: Other Centers, Institutes, or Units > Thomas E. Starzl Transplantation Institute
Date: 1 January 1992
Date Type: Publication
Journal or Publication Title: Transplantation
Volume: 53
Number: 2
Page Range: 400 - 406
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 0041-1337
Other ID: uls-drl:31735062111269, Starzl CV No. 1334
Date Deposited: 08 Apr 2010 17:22
Last Modified: 13 Oct 2017 21:57
URI: http://d-scholarship.pitt.edu/id/eprint/4720

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