Cross-Match As An Immuno-Oncological Risk Factor For Hepatocellular Carcinoma Recurrence And Inferior Survival After Living Donor Liver Transplantation: A Call For Further Investigation

Background: The success of immunotherapy for patients with hepatocellular carcinoma (HCC) suggests that immune dysregulation occurs in HCC patients. This warrants an immuno-oncological risk assessment in the platform of liver transplantation.Methods: This retrospective single-center study analyzed risk factors for-particularly cross-matching performed through conventional complement-dependent cytotoxicity cross-match tests-and the outcomes of HCC recurrence following living donor liver transplant.Results: A total of 71 patients were included. The median follow-up period was 29.1 months; 17 (23.9%) patients had posttransplant HCC recurrence, and their 1-, 3-, and 5-year-survival rates were 70.6%, 25.7%, and 17.1%, respectively, which were inferior to those of patients without HCC recurrence (87.0%, 80.7%, and 77.2%, respectively; P < .001). In addition to microvascular invasion, positive cross-match results for B cells at 37 degrees C (B- 37 degrees C) or T cells at 4 degrees C (T- 4 degrees C) were associated with inferior overall survival in multivariable analysis after adjustment for tumor status beyond Milan criteria and elevated alpha-fetoprotein levels. Rejection alone cannot be the mechanism underlying the effects of positive cross-match results on patient outcomes. Adjusted survival curves suggested that positive cross-match B- 37 degrees C or T- 4 degrees C was associated with inferior recurrence-free and patient survival, but the robustness of the finding was limited by insufficient power.Conclusions: Additional large-scale studies are required to validate positive cross-match as an immuno-oncological factor associated with HCC recurrence and inferior patient survival.