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

 Ha Eun Kim  ;  Young Ho Yang  ;  Hyo Chae Paik  ;  Su Jin Jeong  ;  Song Yee Kim  ;  Moo Suk Park  ;  Jin Gu Lee 
 JOURNAL OF KOREAN MEDICAL SCIENCE, Vol.37(22) : e177, 2022-06 
Journal Title
Issue Date
Graft Rejection / diagnosis ; Graft Survival ; HLA Antigens ; Histocompatibility Testing / methods ; Humans ; Isoantibodies ; Kidney Transplantation* ; Lung Transplantation* ; Retrospective Studies
Allocation ; Crossmatching ; Histocompatibility ; Lung Transplantation
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.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Song Yee(김송이) ORCID logo https://orcid.org/0000-0001-8627-486X
Kim, Ha Eun(김하은)
Park, Moo Suk(박무석) ORCID logo https://orcid.org/0000-0003-0820-7615
Paik, Hyo Chae(백효채) ORCID logo https://orcid.org/0000-0001-9309-8235
Yang, Young Ho(양영호)
Lee, Jin Gu(이진구)
Jeong, Su Jin(정수진) ORCID logo https://orcid.org/0000-0003-4025-4542
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