Crossmatching with B and T cells and flow cytometry.
1. Hyperacute rejections occurred in 0.6% of 19,415 first cadaver donor grafts and 1.9% of 4,326 regrafts. When grouped into those without preformed cytotoxins, 0.5% first grafts and 1.3% of regrafts had hyperacute rejection. Among patients with cytotoxins 1.3% of first grafts and 2.6% of regrafts had hyperacute rejections. 2. A total of 923 first cadaver donor transplants and 238 multiple transplants were crossmatched by 6 variations of microcytotoxicity tests: standard, long 4-hour incubation, B lymphocytes at 4 degrees C and 37 degrees C and T lymphocytes at 4 degrees C and 37 degrees C. All crossmatching was done in one laboratory. 3. For first cadaver donor transplants, 178 patients with long positive crossmatches and 56 patients with T warm positive crossmatches had a significantly lower survival rate than crossmatch negative patients. Those with short positive (weak), B warm, B cold, and T cold positive crossmatches had the same graft survival as crossmatch negative patients. 4. In regrafted patients from cadaver donors those with a short and T warm positive crossmatches had lower graft survival than crossmatch negative patients. 5. Preformed T warm cytotoxins were associated with lower graft survival in first grafts and B warm cytotoxins were associated with lower graft survival in regrafts. 6. Eight patients with T warm positive crossmatches were successfully transplanted (function at 3 months) after they were shown to have IgM antibodies removable by 2-ME treatment. 7. A total of 136 patients were tested by FCXM at the time of transplant on a retrospective basis. Although all patients were crossmatch negative by the T warm tests, 24 were FCXM positive.(ABSTRACT TRUNCATED AT 250 WORDS)
Iwaki
Y
Y
Lau
M
M
Cook
D J
DJ
Takemoto
S
S
Terasaki
P I
PI
D000961:Antilymphocyte Serum / Q000032:analysis; D001402:B-Lymphocytes / Q000276:immunology; D005434:Flow Cytometry; D006085:Graft Survival; D006680:HLA Antigens; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology* / Q000706:statistics & numerical data; D013601:T-Lymphocytes / Q000276:immunology
D000961:Antilymphocyte Serum; D006680:HLA Antigens