Bile duct complications continue to be a significant cause of bile morbidity after orthotopic liver transplantation, with an incidence of 7% to 34% of patients. 1,2 Bile of duct obstruction, usually due to strictures, biliary leakage, and/or cholangitis, accounts for the majority of these complications. In contrast, although low incidence of chronic rejection has been reported under FK 506-based immunosuppression in early trials of liver transplantation, 3 chronic rejection after liver transplantation occurs in only 5% to 9% of cases, and it remains one of the most common causes of graft loss. 4,5 There have been many conflicting recent reports concerning a relationship between the bile duct-related complications or ductopenic chronic rejection and a positive crossmatch. [6][7][8] . We investigated the outcome of liver grafts from positive crossmatch donors, focusing on biliary complications and ductopenic chronic rejection, and we compared the results to a consecutive negative cross-match control group at the same time.
CASE MATERIALSWe analyzed 306 consecutive adults (more than 16 years of age) primary liver transplant cases performed at Presbyterian University Hospital in Pittsburgh between November 13, 1989, and September 26, 1990. Twenty-eight (9.1%) patients were from a donor whose crossmatch test results were positive (more than 50% of donor lymphocytes were killed by dithiothreitolpretreated recipient serum). Selection of the contemporaneous 278 consecutive control patients whose crossmatch test results were negative when less than 10% of donor lymphocytes were killed, and were doubtfully or weakly positive when 11 % to 49% of donor lymphocytes were killed. None of the 306 patients received ABO blood group-incompatible grafts. All donor livers were preserved by University of Wisconsin solution.The study groups differed in crossmatch status, negative control (group 1, n = 278) and positive group (group 2, n = 28). There was a generally high degree of illness in both the positive crossmatch group and their controls, as defined by the United Network for Organ Sharing (UNOS) stratification (Table 1).
The Crossmatch TestEach recipient's serum was drawn immediately before and after liver transplantation and tested for cytotoxic cross-matching activity before and after treatment with dithiothreitol (DTT), which inactivates IgM antibodies. 9 Donor T lymphocytes isolated from lymph nodes using CD3-conjugated dynabeads (Dynal, Great Neck. NY) were used.