Cross-matching in liver transplantation

Writing in this Journal in 1983, Alan Ting (1) suggested that the cross-match test may be ''the most important contribution of the tissue typing laboratory to clinical renal transplantation''. The dire consequences of transplanting a kidney into a recipient with a positive cross-match are well known; however, Liver transplants are routinely performed across this barrier without suffering the penalty of hyperacute rejection. Between 7% and 33% of patients awaiting their first liver transplant harbor cytotoxic HLA-specific antibodies, and at least half of these patients will be IgG antidonor positive (Tables 1 and 2). It might be expected, therefore, that a large percentage of liver grafts would be lost to hyperacute rejection. In fact, only a few instances of hyperacute rejection have been reported (as discussed below). A positive donor cross-match at transplantation may also be associated with long-term effects on solid organ grafts. In heart transplantation, hyperacute rejection is rare, but transplantation against the cross-match barrier is associated with an increased risk of atherosclerosis (2) and lower graft survival (3-5). In this Overview, we consider the current evidence that the cross-match test may be of use in predicting outcome after Liver transplantation and discuss some of the mechanisms that may enable Liver transplants to resist both the immediate and long-term effects of alloantibody.