Charco R, Vargas V, Balsells J, Lázaro J L, Murio E, Jaurrieta E, Martorell J, Margarit C
Department of Surgery, Hospital General Universitari Vall d'Hebron, Barcelona, Spain.
J Hepatol. 1996 Apr;24(4):452-9. doi: 10.1016/s0168-8278(96)80166-8.
BACKGROUND/AIMS: The role of crossmatching in liver transplantation is controversial. The aim of this study was to investigate retrospectively the effect of sensitization and IgG lymphocytotoxic crossmatching on liver transplantation.
METHODS/RESULTS: Over 5 years, 20 of 243 (8.2%) first liver transplants were performed with a positive crossmatch and their outcome was compared with the remaining 223 performed with a negative crossmatch. Women had a higher incidence of positive crossmatch than men (p < 0.001). Significant differences in mean panel reactive antibody of 2.7% and 43.3% were found in negative and positive crossmatch patients, respectively (p < 0.001). Severe early rejection resulting in graft loss occurred in eight of 20 positive crossmatch patients, and only one of 223 negative crossmatch patients (p < 0.001). Five of the remaining positive crossmatch patients suffered several acute rejection episodes some months after liver transplantation. Two of 20 in the positive crossmatch group developed chronic rejection (10%) compared with ten of 223 negatives (4.4%) (N.S). Nine of 16 positive crossmatch female recipients suffered graft loss and seven died, representing 1-year graft and patient survival of 56% and 43%, respectively. Fifteen of 68 negative crossmatch female recipients presented graft loss and 12 died, accounting for 1-year patient and graft survival of 82% and 78% (p < 0.005), respectively. Five patients (20%) displayed positive crossmatch at the time of retransplantation, compared with 24 (10%) who were negative (N.S).
Our experience confirms the adverse impact of a positive crossmatch in liver transplantation, particularly in female recipients. Candidates with high panel reactive antibody are more likely to display a positive crossmatch, and therefore to develop early severe rejection and graft failure.
背景/目的：交叉配型在肝移植中的作用存在争议。本研究的目的是回顾性调查致敏作用及IgG淋巴细胞毒性交叉配型对肝移植的影响。
方法/结果：在5年多的时间里，243例首次肝移植中有20例（8.2%）交叉配型为阳性，将其结果与其余223例交叉配型为阴性的肝移植结果进行比较。女性交叉配型阳性的发生率高于男性（p<0.001）。交叉配型阴性和阳性患者的平均群体反应性抗体分别为2.7%和43.3%，差异有统计学意义（p<0.001）。20例交叉配型阳性患者中有8例发生严重早期排斥反应导致移植物丢失，而223例交叉配型阴性患者中仅有1例（p<0.001）。其余交叉配型阳性患者中有5例在肝移植数月后发生多次急性排斥反应。交叉配型阳性组20例中有2例发生慢性排斥反应（10%），而交叉配型阴性组223例中有10例（4.4%）（无统计学差异）。16例交叉配型阳性女性受者中有9例移植物丢失，7例死亡，1年移植物和患者生存率分别为56%和43%。68例交叉配型阴性女性受者中有15例移植物丢失，12例死亡，1年患者和移植物生存率分别为82%和78%（p<0.005）。再次移植时5例患者（20%）交叉配型为阳性，而24例（10%）为阴性（无统计学差异）。
我们的经验证实交叉配型阳性在肝移植中具有不利影响，尤其是在女性受者中。群体反应性抗体高的候选者更有可能交叉配型为阳性，从而发生早期严重排斥反应和移植物衰竭。
