Successful Deceased Donor Kidney Transplantation of Highly Sensitized Candidates Across Positive Cross Match and Strong Donor-Specific HLA-DP Antibodies without Desensitization

Rajalingam, Raja; Gae, David D.; Lászik, Zoltán; Tavakol, Mehdi; Webber, Allison B.; Dobi, Deján; Cunniffe, Kelly; Gente, Gilberto da; Hirose, Ryutaro; Roll, Garrett R.; Roberts, John P.

doi:10.1097/01.tp.0000542793.31725.d3

Cited by 1 publication

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“…For example, due to the lower expression of C, DP, and DQ some labs have increased their MFI threshold to account for lower levels of antigen on the surface of cells. Moreover, a recent study has analyzed whether crossing DP mismatches with a positive XM is clinically significant, and surprisingly they show that anti‐DP DSAs are of no consequence to ABMR or ACR rates, although this remains a heavily controversial topic. In addition to MFI thresholds varying depending on the class, locus, and antigen, antibodies against shared epitopes that are expressed across many SABs may produce low MFI values that underrepresent the total amount of antibody present.…”

Section: Complex Scenariosmentioning

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

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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: Complex Scenariosmentioning

confidence: 99%