Long-Term Improvement of Graft Survival in Cadaveric Renal Retransplantation by Flow Cytometric Crossmatching

Bryan, Christopher; Baier, K. A.; Nelson, Paul W.; Luger, Alan M.; Martinez, John; Pierce, G. E.; Ross, Gilbert; Shield, Charles F.; Warady, Bradley A.; Aeder, Mark I.; Helling, Thomas S.

doi:10.1097/00007890-199806270-00475

Cited by 3 publications

(4 citation statements)

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“…We have shown that the use of cut-off values selected by retrospective correlation of FCXM values with the occurrence of AMR, results in higher positive and negative predictive values than previously reported (11). The implementation of these cut-off values in prospective flow cytometric crossmatches in our center resulted in an improvement in longterm graft survival in highly sensitized patients.…”

Section: Discussionmentioning

confidence: 70%

“…Positive cut-off definitions from published research studies include more than 2SD shift above mean channel shift from the negative control (9,10), variable mean channel displacement for T and B cells (11,12), or more than 3SD increase in sample median fluorescence intensity from negative control values with SD derived from previous crossmatches between nonsensitized sera and donor lymphocytes (13). Furthermore, flow cut-off values used to determine a positive or negative crossmatch are not reported as having been validated by retrospective correlation with clinical outcome, with the exception of Kotb et al (14).…”

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confidence: 99%

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

et al. 2009

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Section: Discussionmentioning

confidence: 70%

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confidence: 99%

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

et al. 2009

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“…reviewing the transplant literature up to the year 2000 reveals many reports of small series of transplantations with important differences in histocompatibilitytesting protocols from center to center, and markedly differ ent conclusions drawn regarding the utility of differ ent crossmatch tests. [21][22][23][24][25][26] as the determination of Dsa speci ficity was severely limited by the use of cellbased tests, donor selection focused on optimiza tion of Hla match ing, with the assumption that the closer the match, the lower the likelihood of Dsa presence. the identifica tion of acceptable donors for highly sensitized trans plant candidates was dependent on the identification of a donor whose Hla phenotype most closely matched that of the patient.…”

Section: Key Pointsmentioning

confidence: 99%

Sensitized renal transplant recipients: current protocols and future directions

Gloor

Stegall

2010

Nat Rev Nephrol

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The identification of suitable donor kidneys for transplant candidates with high levels of circulating antibodies against human leukocyte antigen (HLA) is a major challenge and results in prolonged waiting times for transplantation. Technological advances in antibody characterization have permitted a more comprehensive assessment of anti-HLA antibody activity, as well as providing new insights into the clinical effect of HLA antibody class and specificity. Protocols have been developed that enable successful transplantation in patients with donor-specific antibodies (anti-HLA antibodies reactive against their donors). These protocols provide satisfactory early to intermediate-term allograft survival, and constitute an important advance in transplantation. Nevertheless, acute antibody-mediated rejection (AMR) remains a significant challenge, occurring in 20-50% of antibody-incompatible kidney transplantations. Although therapy directed toward lowering donor-specific antibody activity seems to be successful in reversing acute AMR, this condition still has an important negative impact on allograft survival. In addition, subclinical AMR seems to complicate a substantial proportion of positive-crossmatch transplantations even in the absence of allograft dysfunction, and may result in chronic histological abnormalities and shortened allograft function. New interventions for preventing acute AMR, such as anti-C5 antibody-mediated complement blockade and proteasome inhibitor-mediated plasma cell depletion, are promising therapeutic avenues currently under investigation.

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“…The negative impact of preexisting anti-HLA antibody against donor antigens on the continued function of transplanted organs has long been accepted for kidney (12)(13)(14)(15)(16), heart (17)(18)(19), and lung transplants (20). This is especially significant for patients who have had a history of HLA sensitization due to prior transplant, transfusions, and/or multiple pregnancies.…”

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confidence: 99%