LONG TERM IMPACT OF POSITIVE CROSSMATCH DUE TO IgG VERSUS IgM ANTIBODIES IN PRIMARY LIVER TRANSPLANTATION UNDER TACROLIMUS

Abstract

766 Positive lymphocytotoxic crossmatch between recipient serum and donor lymphocytes has been demonstrated to be the cause of poor outcome in renal transplantation. Incubation of recipient serum with DTT (dithiothreitol) causes reduction of disulfide bonds of pentameric IgM complex and hence its inactivation, and has been used to distinguish between IgG positive cross match and IgM positive crossmatch. Successful renal transplant can be performed when crossmatch is positive due to non HLA IgM anti bodies. Aim of the present study is to examine the long-term impact of IgG and IgM positive crossmatch in liver transplantation under Tacrolimus. Material and Method: Between Feb. 90 and Dec. 92, 93 patients had positive crossmatch using Amos modified NIH technique. With DTT treatment 73 patients remained positive (IgG antibody positive) while 20 were rendered negative (IgM antibody positive). Characteristics of the population is shown in the (table).TableAll patients were followed until April 98, mean follow up6.8±0.9 (median 6.9; range 8.2 to 5.4) years. Episodes of rejections were recorded in first 3 months. Results: Patient and graft survivals with rejection episodes are shown below. (Table)TableConclusion: Above data suggests that the rate of rejection in IgG positive cross match is higher than IgM positive cross mach and our previously published reports. The long term 7 year patient survival is 70% and graft survival 64% under tacrolimus, which is comparable to observed in other studies.