Selective Omission of the Donor Cross-Match Before Renal Transplantation

Abstract

Rigorous attention to priming events together with careful antibody screening allows the pre-transplant XM test to be safely omitted in approximately half the patients awaiting renal transplantation. This policy allows a modest reduction in cold ischemia time, but it remains to be seen whether this is of clinical benefit.

Pretransplant Risk Assessment in Renal Allograft Recipients Using Virtual Crossmatching

“…Indeed, organs can be given with priority to sensitized patients with a negative virtualXM. Furthermore, in patients without DSA defined by virtualXM a pretransplant CDCXM or FCXM could be omitted, which will reduce cold ischemic time and the incidence of delayed graft function (22). These potential benefits will make the virtualXM approach of particular interest in lung and heart transplantation (6,23).…”

Back to the future: application of contemporary technology to long-standing questions about the clinical relevance of human leukocyte antigen-specific alloantibodies in renal transplantation

“…In our own center, we took this a step further and introduced a policy of proceeding directly to renal transplantation on the basis of a predicted negative cross-match (virtual cross-match) alone to avoid prolongation of cold ischemia time associated with performing the cross-match test [46]. The decision on whether to omit the pretransplant cross-match test and proceed directly to transplantation in a particular recipient was based on a comprehensive history of potential allosensitizing events and antibody screening using lymphocytotoxic T-and B-cell panel reactivity, flow cytometry, and solid-phase binding assays (initially by enzyme-linked immunosorbent assay and more recently by Luminex).…”

Living donor renal transplantation in the presence of donor-specific human leukocyte antigen antibody detected by solid-phase assay

“…These assays have found use in immune monitoring before and after transplantation and as a "virtual crossmatch" tool for immunologic risk stratification of recipients and selection of potential histocompatible donors [4]. In such application, the absence of preoperatively detectable antibodies to donor HLA connotes a nonsensitized recipient with low risk for acute humoral rejection to justify omitting a prospective final crossmatch [5]. However, the clinical significance of antibodies to donor HLA detectable only by solid-phase testing with a negative crossmatch is not completely defined and remains an important area for further investigation.…”