Clinical relevance of Luminex donor‐specific crossmatches: data from 165 renal transplants

Abstract

The clinical significance of the presence of donor-specific anti-human leucocyte antigen (HLA) antibodies (DSA) prior to renal transplantation detected solely by solid-phase techniques remains unclear. This study was designed to determine the clinical relevance of the recently introduced bead-based Luminex donor-specific crossmatch (LumXm). A group of 165 patients transplanted between 1997 and 2001 were tested. Of 165 recipients transplanted with a negative complement-dependent cytotoxicity crossmatch, 32 proved to have a positive Luminex crossmatch. Sixteen were positive for class I, 15 were positive for class II, 1 was both class I and II positive and 133 recipients were negative. Acute rejection (AR)-free survival for all recipients was 77%, and there was no difference in AR-free survival between LumXm-positive and LumXm-negative recipients. Overall graft survival after a median follow-up time of 8 years was 56%. Recipients with a positive class I LumXm had worse long-term graft survival (P = 0.006). In recipients with a positive class I LumXm, 5-year graft survival was 41% vs 70% in negative patients and 10-year graft survival was 27% vs 56%. Positivity for class II LumXm was not a significant risk factor for graft failure (P = 0.7). In conclusion, pretransplant DSA detected by the LumXm had no impact on AR episodes. Class II LumXm positivity proved no significant risk factor for graft failure, but the value of the class II LumXm is questionable. A positive class I LumXm resulted in worse long-term graft survival compared with a negative one.

Donor-Specific Antibody Levels and Three Generations of Crossmatches to Predict Antibody-Mediated Rejection in Kidney Transplantation

“…Hence, the specificity is in the same range as the B-CXM and T-FXM, but the sensitivity is higher. In contrast, the LXM-II was not predictive for AMR, similar to that in the studies of Billen et al (9,10). Until now FXM was the most sensitive technique, but despite some centers strongly support a broad use of FXM (29), the complexity of the test and a persistent debate about the relevance of positive FXM for graft survival has prevented its larger utilization (40,41).…”

Luminex and antibody detection in kidney transplantation

“…This correlation allowed prediction of the result of flow cytometry and CDC crossmatches in 92.8 and 92.4 % of cases. One of the major issues in virtual crossmatch using solid-phase assays is nonstandardized interpretation; therefore, antibody strength and titer, complement fixation, and sensitization events must be accurately considered [41,43,44]. Gandhi et al [45], in a retrospective study on heart transplantation, defined a virtual crossmatch as negative when MFI values, referring to antibodies identified by SA, were \300, and as positive for MFI values [1500.…”

Antibody-Mediated Rejection in Kidney Transplant Recipients

“…The Luminex system was found to be rather effective in determining the significant HLA antibodies in patients waiting for repeated kidney transplantation (Marrari and Duquesnoy, 2010). However, issues of standardization of the method and interpretation of obtained results from the point of view of making a correct decision for treatment of patients are still being discussed (Billen et al, 2009;Cecka, 2011).…”