Significance of a positive T-lymphocytic crossmatch in liver and combined liver and kidney transplantation

Abstract

1018 In contrast to kidney transplants a positive crossmatch is no contraindication for a liver transplantation (OLT) due to the resistance of the liver to antibody mediated rejection. Additionally a liver graft is suspected to have protective effects for kidney grafts when transplanted simultaneously. The aim of this study was to evaluate the effect of a positive crossmatch on outcome after OLT and combined liver and kidney transplantation (CLKTx). We analysed retrospectively the impact of a positive crossmatch on graft survival, acute and steroid resistant rejection episodes after OLT and CLKTx in 824 patients (pts). 18/824 (2.2%) underwent CLKTx. A total of 50/824 (6%) pts had a positive crossmatch, 45/806 (5.6%) OLTs and 5/18 (28%) CLKTxs. Follow-up ranged from 1 to 122.5 months (median 45.8 months). Immunosuppression consisted of either Cyclosporine (CSA) based or Tacrolimus (FK) based regimens. (Table)Table: Incidence of liver graft rejection episodes One-, two- and five year graft survival rates of transplants with a positive crossmatch were 89.6%, 85.2%, and 75.3% respectively and 88%, 83% and 77.5% in negative T-cell crossmatch recipients. Additionally the incidence of acute and steroid resistant rejection was not increased in pts with a positive crossmatch compared to pts with a negative crossmatch. None of the pts with a positive crossmatch and CLKTx underwent a hyperacute rejection and kidney graft survival in pts with a positive crossmatch was 100%. Only 1/18 pts with CLKTx experienced an acute rejection of the kidney graft. This patient had a positive crossmatch. In conclusion a positive crossmatch is no contraindication for OLT and CLKTx. Furthermore not having to wait for results of donor/recipient crossmatching can shorten the cold ischemia time and may improve the outcome.