Improved Graft Survival in Highly Sensitized Patients Undergoing Renal Transplantation After the Introduction of a Clinically Validated Flow Cytometry Crossmatch

Limaye, Sandhya; O’Kelly, Patrick; Harmon, Grainne; O'Neill, D; Dorman, Anthony; Walshe, J.; Donohoe, J.; Little, Dilly; Conlon, Peter J.; Keogan, M.

doi:10.1097/tp.0b013e31819d17b0

Cited by 24 publications

(25 citation statements)

References 17 publications

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“…Our data are in accordance with findings by Limaye et al [14], who also analyzed the negative predictive value of T-cell FCXM for antibody-mediated rejection. Compared with their study, we used a modified method and performed repeated measurements in most recipients, yielding a higher negative predictive value (99% vs 90%).…”

Section: Discussionsupporting

confidence: 95%

“…It must be emphasized that FCXM data analysis lacks standardization [14], and that cut-off definitions vary greatly, e.g., among participants of UK NEQAS external quality controls. The cut-off defined by ROC curve analysis (22 delta MFI) and by twofold SD (19 delta MFI), as mostly used in UK NEQAS external quality controls, is rather similar.…”

Section: Discussionmentioning

confidence: 99%

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High negative predictive value of an amplified flow cytometry crossmatch before living donor kidney transplantation

et al. 2010

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Section: Discussionsupporting

confidence: 95%

Section: Discussionmentioning

confidence: 99%

High negative predictive value of an amplified flow cytometry crossmatch before living donor kidney transplantation

et al. 2010

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“…Patients with renal transplant have new immunosuppressant medications and protocols that reduced graft rejection and increased patient survival. 8,9 Also a strategy of "pre-emptive" renal transplantation has been adopted to avoid dialysis and its associated high mortality. 10,11 Similarly, efforts to reduce cardiovascular mortality through treatment of hypercholesterolemia and hypertension and by encouraging smoking cessation may have reduced mortality both pre-and post-ESRD.…”

mentioning

confidence: 99%

Risk for ESRD in Type 1 Diabetes Remains High Despite Renoprotection

Rosolowsky

Skupień

Smiles

et al. 2011

Journal of the American Society of Nephrology

170

174

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Historically, patients with type 1 diabetes and macroalbuminuria had high competing risks: cardiovascular death or renal failure. Here, we assessed these risks in patients receiving therapies implemented during the last 30 years. Between 1991 and 2004, we enrolled 423 white patients with type 1 diabetes who developed macroalbuminuria (albumin excretion rate, Ն300 g/min). With follow-up for 98% through 2008, ESRD developed in 172 patients (incidence rate, 5.8/100 person-years), and 29 died without ESRD (mortality rate, 1/100 person-years). The majority of these outcomes occurred between ages 36 and 52 years with durations of diabetes of 21 to 37 years. The 15-year cumulative risks were 52% for ESRD and 11% for pre-ESRD death. During the 15 years of follow-up, the use of renoprotective treatment increased from 56 to 82%, and BP and lipid levels improved significantly; however, the risks for both ESRD and pre-ESRD death did not change over the years analyzed. There were 70 post-ESRD deaths, and the mortality rate was very similar during the 1990s and the 2000s (11/100 person-years versus 12/100 person-years, respectively). Mortality was low in patients who received a pre-emptive kidney transplant (1/100 person-years), although these patients did not differ from dialyzed patients with regard to predialysis eGFR, sex, age at onset of ESRD, or duration of diabetes. In conclusion, despite the widespread adoption of renoprotective treatment, patients with type 1 diabetes and macroalbuminuria remain at high risk for ESRD, suggesting that more effective therapies are desperately needed.

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“…Furthermore, the antibody subtype can be determined by the isotype specificity of the fluorescently labeled detection antibody (ie, IgG, IgM, or IgA). 9 Moreover, the likelihood of complement activation can be determined by choosing a detection antibody that binds only to IgG1 and IgG3 and not to IgG2 and IgG4.…”

Section: Figure 1 Complement-dependent Cytotoxicity Crossmatchmentioning

confidence: 99%

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Desoutter

Apithy²,

Guillaume³

2017

Exp Clin Transplant

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Preformed donor-specific antibodies against human leukocyte antigen can induce antibody-mediated rejection after organ transplant. Hence, future transplant recipients undergo pretransplant screening for preformed antibodies (ie, virtual crossmatch). Subsequently, prospective (analytic) crossmatching is performed using conventional, complementdependent cytotoxicity assays and/or flow cytometrybased methods. The present article reviews factors that must be considered when unexpected, positive, prospective crossmatches are observed. First, the prozone effect caused by the interference of complement or immunoglobulin M must be abrogated by treating the serum with moderate heat, dilution, hypotonic dialysis, EDTA, or dithiothreitol. Second, the physician must check for the presence of potentially interfering autoantibodies (in a context of autoimmune disease or human immunodeficiency virus infection) or therapeutic antibodies (such as rituximab and antithymocyte globulin). In conclusion, knowledge of each assay's technical characteristics will enable the physician to reliably interpret any discrepancies. The reasons for an unexpected, positive, prospective crossmatch must be elucidated before transplant to ensure efficient organ allocation and optimize patient outcomes.

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Improved Graft Survival in Highly Sensitized Patients Undergoing Renal Transplantation After the Introduction of a Clinically Validated Flow Cytometry Crossmatch

Abstract: Our data demonstrate that prospective FCXM improves renal transplant outcome in highly sensitized patients, provided that cut-off values are carefully validated and results interpreted in the context of sensitization history and antibody screening results.

Cited by 24 publications

References 17 publications

High negative predictive value of an amplified flow cytometry crossmatch before living donor kidney transplantation

High negative predictive value of an amplified flow cytometry crossmatch before living donor kidney transplantation

Risk for ESRD in Type 1 Diabetes Remains High Despite Renoprotection

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