Flow cytometry crossmatch and kidney graft outcome

Piazza, A.; Borrelli, Laura A.; Buonomo, Oreste Claudio; Pisani, F.; Valeri, M; Torlone, N.; Felici, Angelina; Monaco, P. I.; Adorno, D.; Casciani, Carlo Umberto

doi:10.1016/s0041-1345(98)01642-x

Cited by 7 publications

(8 citation statements)

References 11 publications

(10 reference statements)

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“…Fortunately, both the patient and graft survival rates of ABO‐incompatible renal transplantation were almost identical with those of the ABO‐compatible group [2]. Currently, we can detect the presence of very weak anti‐donor antibodies before transplant operations by the FCXM technique [4]. FCXM is an effective method to pick up weakly pre‐sensitized patients who have been overlooked by ordinary LCT‐XM and might be at a high risk for severe acute humoral rejection under the usual immunosuppressive regimen [5].…”

Section: Discussionmentioning

confidence: 94%

Acute humoral rejection of kidney allografts in patients with a positive flow cytometry crossmatch (FCXM)

Takeda

Uchida

Haba

et al. 2000

Clinical Transplantation

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The patients with a positive flow cytometry crossmatch (FCXM) are categorized as a high-risk group causing hyperacute or accelerated acute rejection after kidney transplantation. According to the successful results of ABO-incompatible renal transplantation, we have performed the living related transplant operations in the recipients with positive FCXM for donor T cells, but having a negative complement-dependent lymphocytotoxic reaction test. We have followed the clinical course of 4 FCXM-positive patients, and 2 of them have developed acute humoral rejection. We report the strategies for FCXM-positive living kidney transplantations and the characteristics of pathological findings of acute humoral rejection in FCXM-positive renal transplants. We have had few episodes of acute humoral rejection in ABO-incompatible kidney transplantations under immunosuppressive regimens, including cyclophosphamide, but 2 patients of 4 with FCXM-positive kidney transplantations developed acute humoral rejections. The differences in immunosuppressive regimen between ABO-incompatible and FCXM-positive kidney transplantations concern anti-lymphocyte globulin (ALG) and splenectomy. We have not performed splenectomy and ALG administration in FCXM-positive kidney transplantations. Severe acute rejection episodes have been experienced on post-operative days 7 and 9 in 2 of 4 FCXM-positive recipients. The early acute rejection episodes were clinically and pathologically diagnosed as typical humoral rejections. We have examined an immunofluorescent study to prove the diagnosis of humoral rejection in FCXM-positive kidney transplantations; both immunoglobulin M and C3 were positive for the whole course of humoral rejection. The 2 patients with acute humoral rejection recovered after treatment with double filtration plasmapheresis or plasma exchange to remove their anti-donor antibodies. The gold standard of success in FCXM-positive kidney transplantations is to suppress the production and reduce the level of anti-donor antibodies after transplant operations.

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Section: Discussionmentioning

confidence: 94%

Acute humoral rejection of kidney allografts in patients with a positive flow cytometry crossmatch (FCXM)

Takeda

Uchida

Haba

et al. 2000

Clinical Transplantation

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“…(1,2,(18)(19)(20) Moreover, posttransplant presence of DSA after restimulation of pre-viously sensitized memory population to donor antigens or due to formation of de novo DSA would increase the risk of acute and chronic rejection and decrease the allograft survival. (11)(12)(13)(14)(15)(16) In this study, we have prospectively monitored 11 kidney transplant recipients for the presence and the formation of DSA by FCXM during 1 year after transplantation. In one patient, the antibody was detected only at 1 week posttransplant and disappeared at 1 month follow up serum; however, the other patient who already had low titer DSA undetectable by CDCXM before transplantation, the antibody titer increased and persisted until 1 month posttransplant.…”

Section: Discussionmentioning

confidence: 99%

“…(10) Posttransplant presence of DSA, due to restimulation of previously sensitized memory population to donor antigens or due to formation of de novo DSA, has been reported to increase the risk for acute and chronic rejection and decrease allograft survival. (11)(12)(13)(14)(15)(16) FCXM has clear advantages compared to CDCXM in terms of sensitivity and laboratory practicability for simultaneous evaluation of T and B lymphocytes; it allows less subjective reading of results and repeated measurement of DSA, although it needs more or less to be measured by technical experts and its results interpreted by clinical experts. (17) In this study, we have measured the presence of pretransplant DSA in kidney transplant patients by CDCXM and FCXM and have continuously monitored the posttransplant DSA up to 1 year by FCXM.…”

Section: Introductionmentioning

confidence: 99%

Continuous Monitoring of Donor Specific Anti-HLA Antibody in Kidney Transplantation Patients

Kang

Kim

Choi

et al. 2009

Korean J Transplant

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Background: A positive reaction at flow cytometry crossmatch (FCXM) has been highlighted by its predictive value for clinical outcome in kidney transplantation after accumulation of large clinical data. The detection of de novo development of anti-HLA antibodies after transplantation is associated with increased rejection and decreased graft survival. In this study, we report the experience for the detection of anti-donor specific antibody (DSA) by more sensitive FCXM methods in renal transplantation patients.Methods: T and B cell FCXMs were performed on 11 pretransplant and 51 posttransplant sera from 11 patients who received renal grafts between 2004 and 2005. The posttransplant sera were collected in specific and regular intervals from posttranspant 1 week to 1 year.Results: Among 62 sera, four (7.8%) from 2 patients showed positive FCXM. In one patient, pretransplant serum which was negative at previous CDCXM, and 2 consecutive sera collected at 1 week and 1 month after transplantation were positive at FCXM. And the antibody identified was B51 which was specific for one of donor alleles (DSA). In another patient, FCXM became positive 1 week after transplantation although pretransplant serum had negative results at both CDCXM and FCXM. Both patients had experienced more than one rejection episodes.Conclusions: Detection of DSA with more sensitive technique such as flow cytometry based method clearly displayed a beneficial effect for prediction of clinical outcome as a part of pretransplant compatibility test, and also as a posttransplant monitoring test to identify the de novo production of clinically significant DSA.

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“…Antibody is detected and measured by surface fluorescence of the lymphocytes. The FCXM can be one to three logs more sensitive than the AHG-CDC assay (depending on the serum/cell combination), with a major advantage that antibody reactivity can be independently and simultaneously evaluated on donor T and B lymphocytes [51,52]. In addition, because the FCXM is a semiquantitative measure of antibody binding, it can be less subjective than visual assessment of cell death in complementdependent assays.…”

Section: Learning From Present Transplantation Medicinementioning

confidence: 99%

Immunogenicity and Allogenicity: A Challenge of Stem Cell Therapy

Charron

Suberbielle-Boissel

Al-Daccak

2008

J. of Cardiovasc. Trans. Res.

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As age progresses, the regenerative power of one's own pluripotent stem cells is often inadequate to sustain normal tissue function. Consequently, the incidence of chronic and degenerative diseases has significantly increased. The derivation of adult tissues and organs from a variety of stem cell sources represents the starting mark for regenerative medicine. It is currently considered a developing mean to repair, restore, maintain, or enhance organ functioning through life span. Recent advances in human embryonic stem cells (hESC) research, however, made the prospect of cell replacement therapy even more compelling and highlighted hESC as a fast track in the therapeutic hope. Among the hurdles which have been largely overlooked in the excitement over the expected benefit is the immunogenicity. Indeed, beyond the clear need to establish the safety of hESC and their derived tissues in terms of tumorogenicity and potential to transmit infections, the challenge is to overcome the immunological barriers to their transplantation.

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Flow cytometry crossmatch and kidney graft outcome

Cited by 7 publications

References 11 publications

Acute humoral rejection of kidney allografts in patients with a positive flow cytometry crossmatch (FCXM)

Acute humoral rejection of kidney allografts in patients with a positive flow cytometry crossmatch (FCXM)

Continuous Monitoring of Donor Specific Anti-HLA Antibody in Kidney Transplantation Patients

Immunogenicity and Allogenicity: A Challenge of Stem Cell Therapy

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