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Renal Transplantation With Final Allocation Based on the Virtual Crossmatch. Am J Transplant 2016 05;16(5):1503-15



Pubmed ID




Scopus ID

2-s2.0-84958087413   30 Citations


Solid phase immunoassays (SPI) are now routinely used to detect HLA antibodies. However, the flow cytometric crossmatch (FCXM) remains the established method for assessing final donor-recipient compatibility. Since 2005 we have followed a protocol whereby the final allocation decision for renal transplantation is based on SPI (not the FCXM). Here we report long-term graft outcomes for 508 consecutive kidney transplants using this protocol. All recipients were negative for donor-specific antibody by SPI. Primary outcomes are graft survival and incidence of acute rejection within 1 year (AR <1 year) for FCXM+ (n = 54) and FCXM- (n = 454) recipients. Median follow-up is 7.1 years. FCXM+ recipients were significantly different from FCXM- recipients for the following risk factors: living donor (24% vs. 39%, p = 0.03), duration of dialysis (31.0 months vs. 13.5 months, p = 0.008), retransplants (17% vs. 7.3%, p = 0.04), % sensitized (63% vs. 19%, p = 0.001), and PRA >80% (20% vs. 4.8%, p = 0.001). Despite these differences, 5-year actual graft survival rates are 87% and 84%, respectively. AR <1 year occurred in 13% FCXM+ and 12% FCXM- recipients. Crossmatch status was not associated with graft outcomes in any univariate or multivariate model. Renal transplantation can be performed successfully, using SPI as the definitive test for donor-recipient compatibility.

Author List

Johnson CP, Schiller JJ, Zhu YR, Hariharan S, Roza AM, Cronin DC, Shames BD, Ellis TM


Christopher P. Johnson MD Professor in the Surgery department at Medical College of Wisconsin
Allan M. Roza MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Blood Grouping and Crossmatching
Flow Cytometry
Follow-Up Studies
Graft Rejection
Graft Survival
Health Care Rationing
Histocompatibility Testing
Kidney Transplantation
Middle Aged
Retrospective Studies
Risk Factors
Tissue Donors
Tissue and Organ Procurement
jenkins-FCD Prod-478 d1509cf07a111124a2d122fd3df854cc0b993c00