TY - JOUR
T1 - Assessing risk in liver transplantation
T2 - Special reference to the significance of a positive cytotoxic crossmatch
AU - Doyle, Howard R.
AU - Marino, Ignazio R.
AU - Morelli, Franca
AU - Doria, Cataldo
AU - Aldrighetti, Luca
AU - McMichael, John
AU - Martell, Joan
AU - Gayowski, Timothy
AU - Starzl, Thomas E.
PY - 1996
Y1 - 1996
N2 - Objective: The authors determined the impact of a positive cytotoxic crossmatch on the outcome of liver transplantation. Summary Background Data: Liver allografts rarely undergo hyperacute rejection, but transplants performed across a positive cytotoxic crossmatch tend to follow a different clinical course, with higher intraoperative blood use, postoperative graft dysfunction, and, in some oases, graft loss. How this affects overall graft survival has not been determined. Methods: The authors provide a retrospective analysis of 1520 liver transplants performed between November 1989 and December 1993, with a minimum follow-up of 1 year. All cases had a cytotoxic crossmatch using serum pretreated with dithiothreitol. Results: There were 1390 negative crossmatch and 130 positive crossmatch cases. There was no difference in overall graft survival, although early survival rates were lower in the positive crossmatch group, with the maximum difference at 6 months: 0.76 (95% confidence interval, 0.74-0.78) for a negative crossmatch versus 0.68 (95% confidence interval, 0.61- 0.77) for a positive crossmatch. These differences become negligible by the 2- year mark. Using stepwise logistic regression, the authors identified seven variables independently associated with outcome: 1) donor age, 2) donor gender, 3) prior liver transplant, 4) medical urgency status, 5) ischemia time, 6) indication for transplantation, and 7) primary immunosuppressant. Conclusions: The cytotoxic crossmatch is not statistically associated with overall graft survival after liver transplantation. However, early failure rates are higher in the positive crossmatch cases, a difference that disappears by the second year.
AB - Objective: The authors determined the impact of a positive cytotoxic crossmatch on the outcome of liver transplantation. Summary Background Data: Liver allografts rarely undergo hyperacute rejection, but transplants performed across a positive cytotoxic crossmatch tend to follow a different clinical course, with higher intraoperative blood use, postoperative graft dysfunction, and, in some oases, graft loss. How this affects overall graft survival has not been determined. Methods: The authors provide a retrospective analysis of 1520 liver transplants performed between November 1989 and December 1993, with a minimum follow-up of 1 year. All cases had a cytotoxic crossmatch using serum pretreated with dithiothreitol. Results: There were 1390 negative crossmatch and 130 positive crossmatch cases. There was no difference in overall graft survival, although early survival rates were lower in the positive crossmatch group, with the maximum difference at 6 months: 0.76 (95% confidence interval, 0.74-0.78) for a negative crossmatch versus 0.68 (95% confidence interval, 0.61- 0.77) for a positive crossmatch. These differences become negligible by the 2- year mark. Using stepwise logistic regression, the authors identified seven variables independently associated with outcome: 1) donor age, 2) donor gender, 3) prior liver transplant, 4) medical urgency status, 5) ischemia time, 6) indication for transplantation, and 7) primary immunosuppressant. Conclusions: The cytotoxic crossmatch is not statistically associated with overall graft survival after liver transplantation. However, early failure rates are higher in the positive crossmatch cases, a difference that disappears by the second year.
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U2 - 10.1097/00000658-199608000-00009
DO - 10.1097/00000658-199608000-00009
M3 - Article
C2 - 8757380
AN - SCOPUS:0029784082
SN - 0003-4932
VL - 224
SP - 168
EP - 177
JO - Annals of surgery
JF - Annals of surgery
IS - 2
ER -