Phasing out the pre-transplant cytotoxicity crossmatch: Are we missing something?

Abstract

Introduction: The anti-human globulin-enhanced complement-dependent cytotoxicity crossmatch (AHG-CDCXM) assay has been used to assess the presence of donor-specific antibodies (DSA) in recipient’s serum before kidney transplantation. The flow cytometric crossmatch (FCXM) assay was first introduced as an additional test. The aim of this study was to clinically validate the single use of the FCXM assay. Methods: This study compared the outcomes of a cohort of kidney transplant patients that underwent FCXM only (FCXM group) versus a cohort of kidney transplant patients that underwent AHG-CDCXM (control group). Results: Ninety-seven patients in the FCXM group and 98 controls were included. All crossmatches in the control group were negative. One patient in the FCXM group had a positive B cell crossmatch. One year after transplantation, there were no significant differences in patient survival (p = 0.591) and graft survival (p = 0.692) between the groups. Also, no significant difference was found in the incidence of Banff ≥ 1A acute cellular rejection episodes (p = 0.289). However, acute antibody-mediated rejections occurred in 3 controls (p = 0.028). Conclusion: The results showed that discontinuing the AHG-CDCXM assay does not modify the clinical outcomes in a 1-year follow-up.

The CDC crossmatch in the era of flow cytometric cross-match and single antigen beads

“…In this issue, Abud et al (2021) compare a cohort of patients with pre-transplant assessment performed by CDC-XM only to a subsequent cohort transplanted after assessment by FCXM only 7 . There was no difference in the one-year patient survival or graft survival between the two groups, although 2/15 graft losses were due to immunological causes in the CDC-XM group, compared to 0/15 in the FXCM group, and 3/68 patients in the CDC-XM group had acute ABMR on biopsy, compared to 0/63 in the FCXM group.…”