Evaluation of Flowcytometric Crossmatching in Renal Allograft Recipients

Abstract

Forty-four cadaver renal allograft recipients who had flowcytometric cross-match (FCXM) testing and sequential quadruple immunosuppression were studied with respect to the number of rejection episodes and the functional viability of the graft in the first year after transplantation. Fourteen of these patients had antibodies to donor T cells by FCXM. All were negative by conventional crossmatch. Multiple-regression analysis with HLA mismatches, panel-reactive antibody (PRA) percentage, flowcytometric channel shifts and transplant number as independent variables revealed that transplant number and high PRA ( > 50%) impacted (p < 0.05) on serum creatinine at 1 month and 1 year, and graft survival at 1 year. In first transplants, a positive FCXM had no impact on 1-year graft survival rates; however, in retransplants, a positive FCXM and/or high PRA had a significant negative impact on 1-year graft survival. This study indicates that the FCXM should be utilized for retransplant patients, and in patients with a high PRA, in an attempt to improve graft survival for these high-risk recipients.

Clinical relevance of antibodies to HLA antigens undetectable by the standard complement-dependent cytotoxicity test

“…The role of anti-HLA antibodies undetectable by classical methods in acute and chronic rejection is still not satisfactorily elucidated. There is prevailing consensus in earlier [13,14,15,161 and more recent studies [17, 181 that a lack of anti-donor antibodies in the FCXM test before a second kidney transplantation is associated with a lower incidence of immunological complications and a better graft prognosis. Nevertheless, data concerning the predictive value of the FCXM test The same patient as patient 6 indicated in Table 5 then grade I11 thrombosis performed before first transplantation are still contradictory [19,20,211.…”