The Risk Factors of Acute Cellular Rejection in Adult Living Donor Liver Transplantation: Doubting the Value of Positive Lymphocytotoxic Cross-match Results

Abstract

Background: The influence of lymphocytotoxic cross-match results on acute cellular rejection in adult living donor liver transplantation (LDLT) has not been well examined. Therefore, in this study, we investigated the risk factors of acute rejection, including positive lymphocytotoxic cross-match results. Methods: Patients inquired in this study are adults who underwent their first LDLT between June 1997 and June 2007 (n=382). We reviewed retrospectively the medical records of donors and recipients, including medical history, surgical procedures, and progress, then analyzed the risk factors of acute rejection using Cox’s proportion hazard model. Results: Among the total subjects of 382, 32 recipients had positive lymphocytotoxic cross-match results. Median follow-up duration was 28.0 months (range, 1∼93). Fifty six recipients had suffered at least one or more acute rejection episodes. In univariate analysis, positive lymphocytotoxic cross-match results didn't turn out to be a significant risk factor of acute rejection (p=0.735), while recipient age (P=0.012), HCV-related (P=0.001), MELD score (P=0.042), gender mismatch (P=0.001) and no induction of anti-IL-2 receptor antibody (P=0.034) were revealed as risk factors for acute rejection. Recipient age (P=0.001, Hazard Ratio 0.937, 95% Confidence Interval 0.902∼0.973), gender mismatch (P=0.001, Hazard Ratio 2.970, 95% Confidence Interval 1.524∼5.788), HCV-related (P=0.001, Hazard Ratio 4.313, 95% Confidence Interval 1.786∼10.417) were considered as significant risk factors in multivariate analysis. Conclusions: Positive lymphocytotoxic cross-match results may not be the risk factor for acute rejection. Therefore, it should not be considered as a determinant when matching donors with recipients in adult LDLT.