Mature wines are better: CDC as the leading method to define highly sensitized patients

Doxiadis, Ilias I.N.; Roelen, Dave L.; Claas, Frans H.J.

doi:10.1097/mot.0b013e3283402beb

Cited by 14 publications

(13 citation statements)

References 18 publications

(13 reference statements)

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“…The cases presented in this article strongly suggest the use of the AMS-ELISA as alternative solid phase-based crossmatch procedure to overcome the general problem of artificially positive CDC-CM results. Hence, the results presented here are not at all in accord with attempts to declare the CDC-based procedures as leading methods and as "gold standard" as proposed a few years ago [25]. Quite contrary to this proposal the cases presented here show the general insufficiency of CDC-based assays to lead to valid results under the accompanying immune complex disease SLE.…”

Section: Discussioncontrasting

confidence: 91%

“…From December 2010 the determining factor was not whether these new guidelines were immunologically and diagnostically worthwhile to circumvent erroneous outcomes or not since to date they have been obligatory. Both the publication of the Eurotransplant authorities Doxiadis and co-workers [25] and the corresponding amendment of the guidelines of the German Federal Medical Association from 2010 must be regarded as anachronistic as the use of novel crossmatch assays to substitute or at least to complement the standard CDC-CM has increasingly been discussed over the last 8-10 years due to this procedure's apparent drawbacks. More than 30 years ago, Ozturk and Terasaki already reported that autoantibodies and immune complexes such as rheumatoid factors may lead to false-positive results of CDC-crossmatches [26].…”

Section: Discussionmentioning

confidence: 99%

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Systemic Lupus Erythematosus Leading to Terminal Renal Failure and Excluding Patients from Kidney Allocation Due to Inadequate CDC-based Cross-Matching: Is There a Diagnostic Way out?

Altermann¹

2014

J Clin Cell Immunol

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Systemic lupus erythematosus (SLE) is known to proceed to clinically relevant nephritis in more than 50% of patients and, in about 20% of these patients, to terminal renal failure. Thus, renal replacement therapy including kidney allografting is required for a considerable number of SLE-patients. For allografting patients' donor-specific antibodies against HLA molecules of given donors (DSA) have to be excluded as preformed antibodies against these molecules represent the main cause for hyper-acute or acute rejections. In order to select recipients without these deleterious antibodies the complement-dependent cytotoxicity crossmatch (CDC-XM) assay was developed about forty years ago. Its negative pre-transplant outcome is currently regarded as the most important requirement for a successful kidney graft survival. During the last years several disadvantages of the CDC-based procedure have increasingly been discussed with respect to this assay's high susceptibility to disruptive factors mainly leading to false positive outcomes. As is clearly shown by our case series this holds also true for the underlying disease SLE. We here present the data of SLE-patients initially destined for cadaver kidney donations. They all exhibited positive CDC-XM outcomes for the most part without known historical immunizing events. Furthermore, solid phase-based antibody screening and specification analyses did generally not show anti-HLA antibodies or antibodies directed against HLA-phenotypes of the corresponding donors thus leading to negative results of the so-called virtual crossmatch. Since exclusive virtual cross-matching is not allowed for the acceptance of allografting all of the positive CDC-XM assays were performed as reruns using alternative solid phase-(ELISA-) based crossmatch assays. In best accordance with virtual cross-matching solid phase-based cross-matching did not exhibit DSA. Our data clearly demonstrate the benefit of alternative ELISA-based cross-matching to circumvent CDC-based artefacts and point on the urgent requirement to substitute the historical CDC-based procedure at least for this group of patients.

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Section: Discussioncontrasting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Systemic Lupus Erythematosus Leading to Terminal Renal Failure and Excluding Patients from Kidney Allocation Due to Inadequate CDC-based Cross-Matching: Is There a Diagnostic Way out?

Altermann¹

2014

J Clin Cell Immunol

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“…Thus, the two cases presented here suggest the use of the AMS-ELISA to overcome the general problem of artificially positive CDC-based crossmatch results. However, the results presented are not in accordance with the latest attempts to declare the CDC-based procedures as the leading method for the definition of immunized patients as proposed recently [12]. Quite in contrast they show the general insufficiency of CDC-based assays to lead to valid results under the conditions described demonstrating the urgent need to substitute them at least for special groups of patients.…”

Section: Discussioncontrasting

confidence: 68%

Artificially Positive Crossmatches Not Leading to the Refusal of Kidney Donations due to the Usage of Adequate Diagnostic Tools

Schlaf

Pollok-Kopp²,

Schabel

et al. 2013

Case Reports in Transplantation

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Allografting patients with human leukocyte antigens (HLA) which are recognized by preformed antibodies constitutes the main cause for hyper-acute or acute rejections. In order to select recipients without these donor-specific antibodies, the complement-dependent cytotoxicity crossmatch (CDC-CM) assay was developed as a standard procedure about forty years ago. The negative outcome of pretransplant crossmatching represents the most important requirement for a successful kidney graft survival. The artificially positive outcomes of CDC-based crossmatches due to the underlying disease Systemic Lupus Erythematosus (SLE), however, may lead to the unjustified refusal of adequate kidney grafts. Two prospective female recipients destined for a living as well as for a cadaver kidney donation, respectively, exhibited positive CDC-based crossmatch outcomes although for both patients no historical immunizing events were known. Furthermore, solid phase-based screening or antibody differentiation analyses never led to positive results. Immediate reruns of the CDC-based crossmatch assays using the alternative antibody monitoring system (AMS-)crossmatch ELISA resulted in unequivocally negative outcomes. Consequently both transplantations were performed without any immunological complications for the hitherto follow-up time of 25 and 28 months, respectively. We here show two case reports demonstrating an alternative methodical approach to circumvent CDC-based artefacts and point to the urgent need to substitute the CDC-based crossmatch procedure at least for special groups of patients.

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“…Depending on the prognosis of the patient, the clinician should decide when it is acceptable to take this risk to proceed with transplant recognizing the presence of DSA. In case of highly sensitized patients, DSA detectable by Luminex SAB should not be considered the sole determinant of unacceptable mismatches .…”

Section: Challenging Medical Decisionsmentioning

confidence: 99%

Report of the second joint meeting of ESOT and AST: current pipelines in biotech and pharma

et al. 2013

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Summary Following the first joint meeting organized by the European (ESOT) and American (AST) Societies of Transplantation in 2010, a second joint meeting was held in Nice, France, on October 12–14, 2012 at the Palais de la Mediterannee. Co‐chairs of the scientific advisory committee were Dr. Flavio Vincenti (AST) and Dr. Teun Van Gelder (ESOT). The goal was to discuss the key unmet needs in solid organ transplantation with the opportunity to interrelate current basic research efforts with clinical translation. Thus, the topic of this second meeting “Transformational therapies and diagnostics in transplantation” was devised and a summary of this meeting follows.

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Mature wines are better: CDC as the leading method to define highly sensitized patients

Cited by 14 publications

References 18 publications

Systemic Lupus Erythematosus Leading to Terminal Renal Failure and Excluding Patients from Kidney Allocation Due to Inadequate CDC-based Cross-Matching: Is There a Diagnostic Way out?

Systemic Lupus Erythematosus Leading to Terminal Renal Failure and Excluding Patients from Kidney Allocation Due to Inadequate CDC-based Cross-Matching: Is There a Diagnostic Way out?

Artificially Positive Crossmatches Not Leading to the Refusal of Kidney Donations due to the Usage of Adequate Diagnostic Tools

Report of the second joint meeting of ESOT and AST: current pipelines in biotech and pharma

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