Crossmatch Positive Liver Transplantation: Role of Underlying Liver Disease

C. Kubal, R. Mangus, R. Saxena, A. Lobashevsky, N. Higgins, A. Shah, R. Vianna, J. Fridell, J. Tector

Department of Surgery, Division of Transplantation, Indiana University, Indianapolis, IN
Department of Pathology, Indiana University, Indianapolis, IN
Department of Transplant Immunology, Indiana University, Indianapolis, IN

Meeting: 2013 American Transplant Congress

Abstract number: 279

Significance of positive crossmatch in liver transplantation (LT) remains unclear. We evaluated the role of flow cytometry crossmatch (CM) in 1000 consecutive LT with a median follow up of 5 years. All patients received rabbit anti-thymocyte globulin (rATG) with/ without rituximab induction and tacrolimus monotherapy maintenance. CM was positive in 112 (11%) recipients. C4d expression was tested on all liver biopsies with a diagnosis of acute cellular rejection. Two patients developed antibody mediated rejection (AMR). Acute cellular rejection (ACR) was noticed in 3% patients. AMR was treated with plasmapharesis, bortezomib and rATG, whereas ACR was treated with high dose steroids +/- rATG. Positive CM status was associated with significantly higher incidence of ACR (9% vs. 2% in CM-, p<0.01), however 1-year graft survival was comparable (85% vs. 89% in CM-, p=0.26). Patients with autoimmune hepatitis (AIH), primary sclerosing cholangitis (PSC) and primary biliary cirrhosis (PBC) as a group had a tendency towards positive CM status (31%CM+ vs. 17% CM-; p<0.001) as well as developing ACR (9% vs. 2%; p<0.01) [Table 1]. In conclusion, in the setting of positive CM LT, AMR is rare. Despite an increased incidence of ACR, positive CM has no adverse impact on early and long term liver graft survival. Increased incidence of ACR in CM+ patients may be driven by underlying immune mediated disease processes, and this subset of patients may benefit from stronger maintenance immunosuppression.

Table 1: Post transplant outcomes stratified by crossmatch
	All	Negative Crossmatch	Positive Crossmatch	p value
Overall	1000(100%)	888(89%)	112(11%)
ACR	3%	2%	9%	<0.01
ACR by pr. disease
AIH/PSC/PBC	9%	7%^€	17%^§	0.06
Others	2%	2%	5%	0.1
1-yr graft survival	89%	89%	85%	0.26

€: p-value <0.01 for comparison of AR by disease subgroups within negative crossmatch, §: p-value <0.05 for comparison of AR by disease subgroups within positive crossmatch

To cite this abstract in AMA style:

Kubal C, Mangus R, Saxena R, Lobashevsky A, Higgins N, Shah A, Vianna R, Fridell J, Tector J. Crossmatch Positive Liver Transplantation: Role of Underlying Liver Disease [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/crossmatch-positive-liver-transplantation-role-of-underlying-liver-disease/. Accessed May 17, 2025.

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