Principles of Virtual Crossmatch Testing for Kidney Transplantation

Bhaskaran, Madhu; Heidt, Sebastiaan; Muthukumar, Thangamani

doi:10.1016/j.ekir.2022.03.006

Cited by 17 publications

(12 citation statements)

References 50 publications

(107 reference statements)

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“…9 The use of the VXM reduces cold ischemia time, allows for the allocation of donor organs nationally, and reduces wait time and waitlist mortality in kidney transplant recipients. [10][11][12][13] Laboratories participate in proficiency testing and surveys to assess performance among peers according to CMS regulations. However, thus far, proficiency testing is limited to each test and analyte but does not assess performance of the entire array of tests or personnel competency used in the decision-making before transplant donor acceptance.…”

Section: Introductionmentioning

confidence: 99%

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Virtual and Reality: An Analysis of the UCLA Virtual Crossmatch Exchanges

et al. 2023

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The “virtual” crossmatch (VXM) has become a critical tool to predict the compatibility between an organ donor and a potential recipient. Yet, nonstandardized laboratory practice can lead to variability in VXM interpretation. Therefore, UCLA’s VXM Exchange survey was designed to understand factors that influence the variability of VXM prediction in the presence of HLA donor-specific antibody (DSA). Thirty-six donor blood samples and 72 HLA reference sera were sent to 35 participating laboratories to perform HLA antibody testing, flow crossmatch (FXM), and VXM from 2014 to 2019, consisting of 144 T/B-cell FXM pairs and 112 T/B-cell VXM pairs. In the FXM survey, 86% T-cell FXM and 84% B-cell FXM achieved >80% concordance among laboratories. In the VXM survey, 81% T-cell VXM and 80% VXM achieved >80% concordance. The concordance between FXM and VXM was 79% for T cell and 87% for B cell. The consensus between VXM and FXM was high with strong DSA. However, significant variability was observed in sera with (1) very high titer antibodies that exit prozone effect; (2) weak-to-moderate DSA, particularly in the presence of multiple weak DSAs; and (3) DSA against lowly expressed antigens. With the increasing use the VXM, standardization and continuous learning via exchange surveys will provide better understanding and quality controls for VXM to improve accuracy across all centers.

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Section: Introductionmentioning

confidence: 99%

“…9 The use of the VXM reduces cold ischemia time, allows for the allocation of donor organs nationally, and reduces wait time and waitlist mortality in kidney transplant recipients. 10-13…”

Section: Introductionmentioning

confidence: 99%

Virtual and Reality: An Analysis of the UCLA Virtual Crossmatch Exchanges

et al. 2023

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“…Established RA algorithms 5 or the ET-specific kidney transplantation outcome prediction tool 29 may assist in the decision-making process and possibly help to save lives and give patients the chance to overcome dialysis. The introduction of virtual crossmatching in ET will reduce CITs 30 and hopefully increase both acceptability of RA offers and the respective outcomes in future.…”

Section: Discussionmentioning

confidence: 99%

Rescue Allocation Modes in Eurotransplant Kidney Transplantation: Recipient Oriented Extended Allocation Versus Competitive Rescue Allocation—A Retrospective Multicenter Outcome Analysis

Assfalg,

Miller,

Stocker

et al. 2023

Transplantation

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Background. Whenever the kidney standard allocation (SA) algorithms according to the Eurotransplant (ET) Kidney Allocation System or the Eurotransplant Senior Program fail, rescue allocation (RA) is initiated. There are 2 procedurally different modes of RA: recipient oriented extended allocation (REAL) and competitive rescue allocation (CRA). The objective of this study was to evaluate the association of patient survival and graft failure with RA mode and whether or not it varied across the different ET countries. Methods. The ET database was retrospectively analyzed for donor and recipient clinical and demographic characteristics in association with graft outcomes of deceased donor renal transplantation (DDRT) across all ET countries and centers from 2014 to 2021 using Cox proportional hazards methods. Results. Seventeen thousand six hundred seventy-nine renal transplantations were included (SA 15 658 [89%], REAL 860 [4.9%], and CRA 1161 [6.6%]). In CRA, donors were older, cold ischemia times were longer, and HLA matches were worse in comparison with REAL and especially SA. Multivariable analyses showed comparable graft and recipient survival between SA and REAL; however, CRA was associated with shorter graft survival. Germany performed 76% of all DDRTs after REAL and CRA and the latter mode reduced waiting times by up to 2.9 y. Conclusions. REAL and CRA are used differently in the ET countries according to national donor rates. Both RA schemes optimize graft utilization, lead to acceptable outcomes, and help to stabilize national DDRT programs, especially in Germany.

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“…It is performed electronically in a central location as a “first-pass” crossmatch to facilitate organ acquisition ( Wade et al, 2022 ). VXM is a useful tool performed before kidney allocation since prevent the need for reallocation due to an unexpected positive prospective crossmatch related to a previously undetected HLA antibody or a false-positive reaction ( Bhaskaran et al, 2022 ).…”

Section: Management Of Hyperimmune Subject In the Waiting List For Or...mentioning

confidence: 99%