Journal List > J Korean Soc Transplant > v.23(3) > 1034295

J Korean Soc Transplant. 2009 Dec;23(3):237-243. Korean.
Published online December 31, 2009.  https://doi.org/10.4285/jkstn.2009.23.3.237
Copyright © 2009 The Korean Society for Transplantation
The Risk Factors of Acute Cellular Rejection in Adult Living Donor Liver Transplantation: Doubting the Value of Positive Lymphocytotoxic Cross-match Results
Kyung Uk Jung, M.D., Jae Berm Park, M.D., Jong Man Kim, M.D., Ju Ik Moon, M.D., Gum O Jung, M.D., Jae Min Chun, M.D., Gyu-Seong Choi, M.D., Choon Hyuck David Kwon, M.D., Sung-Joo Kim, M.D., Jae-Won Joh, M.D., and Suk-Koo Lee, M.D.
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Corresponding author (Email: jw.joh@samsung.com )
Received July 30, 2009; Accepted October 14, 2009.

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.

Keywords: Human leukocyte antigen; Lymphocytotoxic cross-match; Acute rejection; Liver transplantation; Living donors

Figures


Fig. 1
Kaplan-Meier rejection-free survival curve of liver transplantations done in the negative (n=350) or positive (n=32) lym - phocytotoxic cross-match. There is no difference in the results (P=0.735).

Abbreviation: LCCM, lymphocytotoxic cross-match.

Click for larger image

Tables


Table 1
The characteristics of the living donor liver transplantation recipients (n=382)
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Table 2
Demographic findings and acute rejection rate in positive and negative cross-matches
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Table 3
FK506 level in positive and negative cross-matches
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Table 4
Risk factors for acute rejection in living donor liver transplantation recipients in the univariate analysis
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Table 5
Risk factors for acute rejection in living donor liver transplantation recipients in the multivariate analysis
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Jae-Won Joh
https://orcid.org/http://orcid.org/0000-0003-1732-6210

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