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

Date

11/26/2015

Pubmed ID

26602886

DOI

10.1111/ajt.13606

Scopus ID

2-s2.0-84958087413   30 Citations

Abstract

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

Authors

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

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