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
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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| Item Type: |
Article
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| Status: |
Published |
| Creators/Authors: |
| Creators | Email | Pitt Username | ORCID  |
|---|
| Takaya, S | | | | | Bronsther, O | | | | | Iwaki, Y | | | | | Nakamura, K | | | | | Abu-Elmagd, K | | | | | Yagihashi, A | | | | | Demetris, AJ | | | | | Kobayashi, M | | | | | Todo, S | | | | | Tzakis, AG | | | | | Fung, JJ | | | | | Starzl, TE | tes11@pitt.edu | TES11 | |
|
| Centers: |
Other Centers, Institutes, Offices, 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 |
| DOI or Unique Handle: |
10.1097/00007890-199202010-00026 |
| 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: |
27 Jan 2019 02:55 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/4720 |
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