Assessing risk in liver transplantation

Special reference to the significance of a positive cytotoxic crossmatch

Howard Doyle, Ignazio R. Marino, Franca Morelli, Cataldo Doria, Luca Aldrighetti, John McMichael, Joan Martell, Timothy Gayowski, Thomas E. Starzl

Research output: Contribution to journalArticle

67 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)168-177
Number of pages10
JournalAnnals of Surgery
Volume224
Issue number2
DOIs
StatePublished - 1996
Externally publishedYes

Fingerprint

Liver Transplantation
Graft Survival
Transplants
Liver
Confidence Intervals
Dithiothreitol
Graft Rejection
Immunosuppressive Agents
Allografts
Ischemia
Transplantation
Logistic Models
Serum

ASJC Scopus subject areas

  • Surgery

Cite this

Assessing risk in liver transplantation : Special reference to the significance of a positive cytotoxic crossmatch. / Doyle, Howard; Marino, Ignazio R.; Morelli, Franca; Doria, Cataldo; Aldrighetti, Luca; McMichael, John; Martell, Joan; Gayowski, Timothy; Starzl, Thomas E.

In: Annals of Surgery, Vol. 224, No. 2, 1996, p. 168-177.

Research output: Contribution to journalArticle

Doyle, H, Marino, IR, Morelli, F, Doria, C, Aldrighetti, L, McMichael, J, Martell, J, Gayowski, T & Starzl, TE 1996, 'Assessing risk in liver transplantation: Special reference to the significance of a positive cytotoxic crossmatch', Annals of Surgery, vol. 224, no. 2, pp. 168-177. https://doi.org/10.1097/00000658-199608000-00009
Doyle, Howard ; Marino, Ignazio R. ; Morelli, Franca ; Doria, Cataldo ; Aldrighetti, Luca ; McMichael, John ; Martell, Joan ; Gayowski, Timothy ; Starzl, Thomas E. / Assessing risk in liver transplantation : Special reference to the significance of a positive cytotoxic crossmatch. In: Annals of Surgery. 1996 ; Vol. 224, No. 2. pp. 168-177.
@article{4dda41b31f6d4cfa80890654e7ee88a0,
title = "Assessing risk in liver transplantation: Special reference to the significance of a positive cytotoxic crossmatch",
abstract = "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.",
author = "Howard Doyle and Marino, {Ignazio R.} and Franca Morelli and Cataldo Doria and Luca Aldrighetti and John McMichael and Joan Martell and Timothy Gayowski and Starzl, {Thomas E.}",
year = "1996",
doi = "10.1097/00000658-199608000-00009",
language = "English (US)",
volume = "224",
pages = "168--177",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Assessing risk in liver transplantation

T2 - Special reference to the significance of a positive cytotoxic crossmatch

AU - Doyle, Howard

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.

UR - http://www.scopus.com/inward/record.url?scp=0029784082&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0029784082&partnerID=8YFLogxK

U2 - 10.1097/00000658-199608000-00009

DO - 10.1097/00000658-199608000-00009

M3 - Article

VL - 224

SP - 168

EP - 177

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 2

ER -