J Korean Med Sci.  2022 Jun;37(22):e177. 10.3346/jkms.2022.37.e177.

The Assessment and Outcomes of Crossmatching in Lung Transplantation in Korean Patients

• Kim HE
• Yang YH
• Paik HC
• Jeong SJ
• Kim SY
• Park MS
• Lee JG

• KMID: 2530419
• DOI: http://doi.org/10.3346/jkms.2022.37.e177

Abstract

Background
In lung transplantation, human leukocyte antigen (HLA) compatibility is not included in the lung allocation score system or considered when placing donor allografts. However, HLA matching may affect the outcomes of lung transplantation. This study evaluated the current assessment status, prevalence, and effects of HLA crossmatching in lung transplantation in Korean patients using nationwide multicenter registry data.
Methods
Two hundred and twenty patients who received lung transplantation at six tertiary hospitals in South Korea between March 2015 and December 2019 were retrospectively reviewed. Clinical data, including general demographic characteristics, primary diagnosis, and pretransplant status of the recipients and donors registered by the Korean Organ Transplant Registry, were retrospectively analyzed. Survival analysis was performed using the Kaplan-Meier method with log-rank tests.
Results
Complement-dependent cytotoxic crossmatch (CDC-XM) was performed in 208 patients (94.5%) and flow cytometric crossmatch (flow-XM) was performed in 125 patients (56.8%). Among them, nine patients (4.1%) showed T cell- and/or B cell-positive crossmatches. The incidences of postoperative complications, including primary graft dysfunction, acute rejection, and chronic allograft dysfunction in positively crossmatched patients, were not significant compared with those in patients without mismatches. Moreover, Kaplan-Meier analyses showed poorer 1-year survival in patients with positive crossmatch according to CDC-XM (P < 0.001) and T lymphocyte XM (P = 0.002) than in patients without mismatches.
Conclusion
Positive CDC and T lymphocyte crossmatching results should be considered in the allocation of donor lungs. If unavailable, the result should be considered for postoperative management in lung transplantation.

Keyword

Lung Transplantation; Crossmatching; Allocation; Histocompatibility

Figure

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  Fig. 1 Impact of positive crossmatching on survival of lung transplant patients. (A) The 1-year and (B) overall survival of lung transplant patients.

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  Fig. 2 Impact of positive CDC and flow crossmatches on survival of lung transplant patients. (A) The 1-year survival according to the results of CDC crossmatch. (B) Overall survival according to the results of CDC crossmatch. (C) The 1-year survival according to the results of flow cytometric crossmatch. (D) Overall survival according to the results of flow cytometric crossmatch.CDC = complement-dependent cytotoxicity.

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  Fig. 3 Survival analysis of positive T and B lymphocyte crossmatches in lung transplantation. (A) The 1-year survival according to the results of T lymphocyte crossmatching. (B) Overall survival according to the results of T lymphocyte crossmatching. (C) The 1-year survival according to the results of B lymphocyte crossmatching. (D) Overall survival according to the results of B lymphocyte crossmatching.

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