A Living Donor Liver Transplantation after Therapeutic Plasmapheresis in a Patient with Positive HLA Crossmatch / 대한수혈학회지

A positive HLA crossmatch in cadevaric liver transplantation is relatively acceptable, but in living donor liver transplantation (LDLT) using relatively small sized grafts, the rejection rates were higher in positive crossmatchcases than in negative cases, as described in several previous reports. We report a case of LDLT performed with therapeutic plasmapheresis, in a recipient with a positive HLA crossmatch to donor before transplantation. The patient was a 56-year-old male patient with liver cirrhosis (UNOS status IIA, MELD score 28) caused by chronic hepatitis B. The HLA crossmatch results were 1:2 and 1:8 positive for NIH-CDC (complement dependent cytotoxicity) and AHG-CDC, respectively. The flow cytometric crossmatch (FCXM) was also positive (T-MFI ratio 9.0 and B-MFI ratio 3.4). With 5 cycles of preoperative therapeutic plasmapheresis, the HLA crossmatch converted to negative and liver transplantation was performed. The liver function of the patient was well maintained for 5 months, without any sign of hyperacute or acute rejection. However, the patient eventually died from suddenly occurred infection-associated hemophagocytic syndrome at 5 months after surgery. Therapeutic plasmapheresis can be considered as one of therapeutic options for LDLT patients with a positive HLA crossmatch to donor.

Plasmapheresis in a Renal Transplant Patient with Positive Crossmatch only Detected by Flow Cytometry / 대한수혈학회지

Complement-dependent cytotoxicity (CDC) has been established as a crossmatch (XM) technique that can effectively prevent hyperacute transplantation rejetion by detecting preformed complement-fixing antibodies. The anti-human globulin crossmatch (AHGXM) has been performed in an effort to improve sensitivity for detecting anti-donor antibodies. Flow cytometry crossmatch (FCXM) was introduced as a more sensitive technique than the traditional CDCXM or AHGXM. A positive pre-transplant FCXM in recipients with a negative CDCXM or AHGXM has been found to be associated with a poor graft survival in several studies. Many clinical studies have focused on suppressing or eliminating anti-donor antibodies through the use of immunosuppresive drugs, immunoadsorption, intravenous immunoglobulin, or plasmapheresis. We performed plasmapheresis with intravenous immunoglobulin and FK 506 for a 38-year old female patient with chronic renal failure to remove anti-donor antibody which was only detected by FCXM. After transplant, no evidence of hyperacute or acute rejection was found. After 6 month, the recipient was surviving with well-functioning graft.

HLA Cross-match Negative Conversion by Therapeutic Plasmapheresis in a Patient with Positive HLA Cross-match / 대한진단검사의학회지

It is well accepted that kidney transplantation cannot be done if the recipient has antibodies showing a positive HLA cross-match to the donor. Recently, Schweitzer and his associates used a combination therapy with plasmapheresis, IV gamma globulin, and potent immunosuppression to induce HLA cross-match negative conversion in patients with a positive HLA cross-match to living donors and they reported good results after the trials. Therefore, we treated a patient with combination therapy who had persistent-positive HLA cross-match to multiple living donors. The patient was a 38-year-old female suffering from chronic renal failure and she showed persistent positive HLA cross-match to multiple living donors. Using a combination therapy with plasmapheresis, IV gamma globulin and immunosuppression, we have successfully achieved a HLA cross-match negative conversion in a patient and we did kidney transplantation without any sign of hyperacute or acute rejection. Although we present possibility of a HLA cross-match negative conversion by combination therapy, especially in a recipient with a low titer cross-match positive to a family donor, further long-term study with more patients is needed for evaluation of the efficacy of this trial.