Clinical Significance of a Positive Flow Crossmatch on the Outcomes of Cadaveric Renal Transplants

• Published in: Transplantation proceedings 2008-07, Vol.40 (6), p.1839-1843
• Main Authors: Ilham, M.A, Winkler, S, Coates, E, Rizzello, A, Rees, T.J, Asderakis, A
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cadaver; Child; Child, Preschool; Drug Therapy, Combination; Female; Flow Cytometry - methods; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Histocompatibility Testing - methods; HLA Antigens - immunology; Humans; Immunoglobulins - immunology; Immunosuppression - methods; Immunosuppressive Agents - therapeutic use; Kidney Transplantation - immunology; Lymphocytes - immunology; Male; Medical sciences; Middle Aged; Reoperation - statistics & numerical data; Sensitivity and Specificity; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue Donors; Tissue, organ and graft immunology; Treatment Outcome
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2008.05.009

Abstract Pretransplantation crossmatching is an integral part of kidney transplantation. Flow cytometric crossmatch (FCXM) is more sensitive than complement-dependent cytotoxic crossmatch (CDC-XM). However, the clinical significance of positive FCXM with negative CDC-XM is controversial. We evaluated FCXM in 455 consecutive deceased donor renal transplants. All had a negative CDC-XM. There were 341 T-cell and B-cell FCXM negative and 38 T-cell and B-cell positive. There was a higher percentage of retransplantations and HLA mismatches (26.3% vs 8.2%, P = .002 and 2.45 vs 1.99, P = .02, respectively) in the FCXM-positive group compared with the FCXM-negative group; 65.8% of the FCXM-positive patients had rejection compared with 49.3% of the FCXM-negative patients (odds ratio [OR] = 1.89, P = .06). FCXM-positive patients had a higher incidence of vascular rejection (28.9% vs 12.6%, OR = 2.68, P = .008). One- and 5-year graft survivals were 84% and 66% in the FCXM-positive group vs 90% and 75% in the FCXM-negative group. Censoring for patient death, 1- and 5-year graft survivals were 84% and 73% in the FCXM-positive group vs 94% and 82% in the FCXM-negative group. There was no difference in renal function between the 2 groups. In conclusion, a positive T-cell and B-cell FCXM transplant with a negative CDC-XM is associated with a higher incidence of rejection, twice the risk of vascular rejection, and a trend toward poorer graft survival.