Postoperative flow cytometry crossmatch in living donor liver transplantation - Clinical significance of humoral immunity in acute rejection

Citation
M. Kasahara et al., Postoperative flow cytometry crossmatch in living donor liver transplantation - Clinical significance of humoral immunity in acute rejection, TRANSPLANT, 67(4), 1999, pp. 568-575
Citations number
38
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Medical Research Diagnosis & Treatment
Journal title
TRANSPLANTATION
ISSN journal
0041-1337 → ACNP
Volume
67
Issue
4
Year of publication
1999
Pages
568 - 575
Database
ISI
SICI code
0041-1337(19990227)67:4<568:PFCCIL>2.0.ZU;2-H
Abstract
Background The role of humoral immunity in acute rejection in solid organ t ransplantation remains controversial, although it is known that the presenc e of antidonor antibodies may precipitate graft rejection. We investigated the clinical relevance of antidonor humoral immunity for living donor liver transplantation (LDLT) by means of now cytometry crossmatch (FCXM). Methods. T cell FCXM using fresh donor peripheral lymphocytes was performed before and up to 1 month after LDLT in 58 patients. Ten patients received ABO-incompatible grafts. IgM and IgG antidonor antibodies were analyzed in relation to clinical acute rejection as defined by liver function tests wit h or without histological evidence. Results. Pretransplantation FCXM was positive for five patients (8.6%), res ulting in two cases of positive posttransplantation FCXM and two rejection episodes. Twelve patients (20.7%) showed positive posttransplantation FCXM. The incidence of acute rejection within 1 month was 100% in FCXM-positive patients and 17.4% in FCXM-negative patients (P<0.001). Thirteen (76.5%) of 17 rejection episodes in ABO-compatible cases were associated with concomi tant antidonor IgM antibody. IgG antibody was also identified in six of the se episodes. Antidonor antibodies disappeared after rejection treatments in all cases, but with some delay in clinical improvement. On the other hand, no antidonor antibodies were detected in any of the four rejection episode s in ABO-incompatible cases. Conclusions. Early acute rejection in LDLT is significantly associated with antidonor T cell antibody formation in ABO-compatible cases. This suggests a definite role for donor-specific humoral immunity in acute rejection. Re jection episodes without antidonor antibodies may suggest graft injury by p ure cellular immunity, or possibly the presence of humoral immunity trigger ed by antigene not present on donor T cells.