Renal Transplantation With Final Allocation Based on the Virtual Crossmatch. Am J Transplant 2016 May;16(5):1503-15
Date
11/26/2015Pubmed ID
26602886DOI
10.1111/ajt.13606Scopus ID
2-s2.0-84958087413 (requires institutional sign-in at Scopus site) 51 CitationsAbstract
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 TMAuthor
Christopher P. Johnson MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
B-LymphocytesBlood 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