title: Improved graft outcome and reduced complications due to flow cytometric crossmatching and DR matching in renal transplantation.
abstract: Several previous studies, including our own, have indicated that flow cytometric assays can identify an at-risk population of kidney transplant recipients. We used the assay for recipient selection for a period of twelve months. Recipients with donor T cell-directed IgG were excluded from transplantation and those with B cell-directed IgG were treated with increased immunosuppression. The transplants performed over this period (n = 126) were compared with an earlier series (n = 118) where, although the flow cytometric crossmatches were performed, the results did not influence patient management. In the series where the flow cytometric crossmatch was used in management, a lower failure rate was found at three months (P = 0.037 chi square), primary non-function was reduced (P less than 0.0001, Mann-Whitney), rejection episodes were reduced (P less than 0.0001, Mann-Whitney) and the hospital stay was shorter (P less than 0.0001, Student's t). The risk factors of ischemic times, panel reactivity, exposure to previous grafts and A/B locus matching were identical between the two groups. However DR matching was found to be higher in the series with the improved results (P less than 0.0001, Mann-Whitney). In view of the significant improvement in graft success and low complication rate, we intend to continue with the policy of recipient selection by flow cytometric crossmatching and DR matching.
authors.affiliation: Department of Surgery, Medical School, University of Newcastle upon Tyne, United Kingdom.
authors.forename: D
authors.initials: D
authors.lastname: Talbot
authors.forename: G
authors.initials: G
authors.lastname: Cavanagh
authors.forename: E
authors.initials: E
authors.lastname: Coates
authors.forename: A L
authors.initials: AL
authors.lastname: Givan
authors.forename: B K
authors.initials: BK
authors.lastname: Shenton
authors.forename: T W
authors.initials: TW
authors.lastname: Lennard
authors.forename: G
authors.initials: G
authors.lastname: Proud
authors.forename: R M
authors.initials: RM
authors.lastname: Taylor
mesh_terms: D000328:Adult; D005260:Female; D005434:Flow Cytometry; D006684:HLA-DR Antigens / Q000032:analysis*; D006650:Histocompatibility Testing; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged
chemical_list: D006684:HLA-DR Antigens