Positive crossmatch in primary human liver allografts under cyclosporine or FK 506 therapy.

Abstract

Hepatic allografts are unusually resistant to hyper-acute rejection, and they function well despite the presence of antidonor lymphocytotoxic antibody (positive crossmatch) with very few exceptions.1–6 We have previously reported that 1- and 2-year hepatic graft survivals were not adversely affected by the lymphocytotoxic antibody and that a positive crossmatch should not be considered as a contraindication for hepatic allotransplantation.4,5 It is true, however, that crossmatch-positive hepatic grafts have been lost repeatedly for inadequately explained reasons at our center as well as at other centers.7–10 The improvement in organ preservation, provided by the University of Wisconsin (UW) solution, might have nearly eliminated the intrinsic graft-related causes of loss from the analysis.11–13 At our center the incidence of so-called primary nonfunction of liver graft used to be between 3.5% and 7.4% with Euro-Collins solution,5–11 but it has been less than 2.0% with UW solution for the last 3 years.11 The incidence of early hepatic retransplantation has also decreased from 20% to 11.3%.11 Thus, we decided to examine, for the third time, the effect of antidonor lymphocytotoxic antibody upon graft survival.