Renal Transplantation With Final Allocation Based on the Virtual Crossmatch

Johnson, Carolyn; Schiller, Jonathan R.; Zhu, Yong-Ran; Hariharan, Sundaram; Roza, Allan M.; Cronin, David; Shames, Brian D.; Ellis, Thomas M.

doi:10.1111/ajt.13606

Cited by 54 publications

(31 citation statements)

References 27 publications

(45 reference statements)

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“…Because of these issues, the VXM is gaining in popularity as an effective approach for many candidates. The VXM can reduce the time to transplantation and decrease cold ischemia time without impacting allograft survival, patient survival, or early rejection rates . Judicious application of the VXM can then allow for grafts to be shared over extended distances without incident even in highly sensitized recipients .…”

Section: Future Of Crossmatchingmentioning

confidence: 99%

“…The VXM can reduce the time to transplantation and decrease cold ischemia time without impacting allograft survival, patient survival, or early rejection rates. 40,41 Judicious application of the VXM can then allow for grafts to be shared over extended distances without incident even in highly sensitized recipients. 42,43 Furthermore, eliminating a prospective physical crossmatch has been shown to decrease both time on waiting list and wait list mortality for lung and cardiac transplant recipients.…”

Section: Future Of Crossmatchingmentioning

confidence: 99%

See 1 more Smart Citation

Out with the old, in with the new: Virtual versus physical crossmatching in the modern era

Morris

Sullivan

Krummey

et al. 2019

HLA

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The virtual crossmatch (VXM) is gaining acceptance as an alternative approach to assess donor:recipient compatibility prior to transplantation. In contrast to a physical crossmatch, the virtual crossmatch does not require viable donor cells but rather relies on complete HLA typing of the donor and current antibody assessment of the recipient. Thus, the VXM can be performed in minutes which allows for faster transplant decisions thereby increasing the likelihood that organs can be shipped across significant distances yet safely transplanted. Here, we present a brief review of the past 50 years of histocompatibility testing; from the original complement‐dependent cytotoxicity crossmatch in 1969 to the new era of molecular HLA typing, solid‐phase antibody testing and virtual crossmatching. These advancements have shaped a paradigm shift in our approach to transplantation. That is, foregoing a prospective physical crossmatch in favor of a VXM. In this review, we undertake an in‐depth analysis of the pros‐ and cons‐ of physical and virtual crossmatching.Finally, we provide objective data on the selected use of the VXM which demonstrate the value of a VXM in lieu of the traditional physical crossmatch for safe and efficient organ transplantation.

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Section: Future Of Crossmatchingmentioning

confidence: 99%

Section: Future Of Crossmatchingmentioning

confidence: 99%

Out with the old, in with the new: Virtual versus physical crossmatching in the modern era

Morris

Sullivan

Krummey

et al. 2019

HLA

View full text Add to dashboard Cite

show abstract

“…This approach has been used successfully in renal transplantation. Johnson et al (80) have reported on a large cohort of patients where the final decision to transplant was based on SAB results rather the FCXM result. When analyzed for clinical outcome based on whether the FCXM was positive or negative, despite the fact the FCXM positive group were more “at risk” than the FCXM negative group, the transplant outcomes were comparable, justifying the use of the VXM in preference to the results obtained by FCXM.…”

Section: The Virtual Crossmatchmentioning

confidence: 99%

Detection of HLA Antibodies in Organ Transplant Recipients – Triumphs and Challenges of the Solid Phase Bead Assay

Tait

2016

Front. Immunol.

107

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This review outlines the development of human leukocyte antigen (HLA) antibody detection assays and their use in organ transplantation in both antibody screening and crossmatching. The development of sensitive solid phase assays such as the enzyme-linked immunosorbent assay technique, and in particular the bead-based technology has revolutionized this field over the last 10–15 years. This revolution however has created a new paradigm in clinical decision making with respect to the detection of low level pretransplant HLA sensitization and its clinical relevance. The relative sensitivities of the assays used are discussed and the relevance of conflicting inter-assay results. Each assay has its advantages and disadvantages and these are discussed. Over the last decade, the bead-based assay utilizing the Luminex® fluorocytometer instrument has become established as the “gold standard” for HLA antibody testing. However, there are still unresolved issues surrounding this technique, such as the presence of denatured HLA molecules on the beads which reveal cryptic epitopes and the issue of appropriate fluorescence cut off values for positivity. The assay has been modified to detect complement binding (CB) in addition to non-complement binding (NCB) HLA antibodies although the clinical relevance of the CB and NCB IgG isotypes is not fully resolved. The increase sensitivity of the Luminex® bead assay over the complement-dependent cytotoxicity crossmatch has permitted the concept of the “virtual crossmatch” whereby the crossmatch is predicted to a high degree of accuracy based on the HLA antibody specificities detected by the solid phase assay. Dialog between clinicians and laboratory staff on an individual patient basis is essential for correct clinical decision making based on HLA antibody results obtained by the various techniques.

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“…This method allows for the sensitivity of flow crossmatch combined with identifying specific antibody. Johnson et al found that the final transplant decision could be taken on the basis of the virtual crossmatch irrespective of the flow cytometry without significant difference in the clinical outcome in those who were flow cytometry positive but virtual crossmatch negative [17]. A recent study on pancreas transplants showed a reduced cold ischemia time when virtual crossmatch was used in lieu of flow cytometry [18].…”

Section: The Virtual Crossmatchmentioning

confidence: 99%

An Update on Crossmatch Techniques in Transplantation

Kumar¹,

Mohiuddin²,

Sharma³

et al. 2017

J Kidney

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Crossmatch techniques formulated nearly a half century ago remain the bedrock of transplantation science. While initial methods relied on complement dependent cytotoxicity. More recently additions to the transplant physician's immunologic armamentarium have arrived in both cell-based as well as solid phase assays. Flow cytometry is useful in previously sensitized patients while bead technology has revolutionised HLA antibody testing. The virtual crossmatch uses bead technology to detect specific recipient antibodies without requiring donor serum. We present a concise review of the techniques available, their basis and comparison between them so as to better understand their respective applications.

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Renal Transplantation With Final Allocation Based on the Virtual Crossmatch

Cited by 54 publications

References 27 publications

Out with the old, in with the new: Virtual versus physical crossmatching in the modern era

Out with the old, in with the new: Virtual versus physical crossmatching in the modern era

Detection of HLA Antibodies in Organ Transplant Recipients – Triumphs and Challenges of the Solid Phase Bead Assay

An Update on Crossmatch Techniques in Transplantation

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