title: Flow cytometry-detected IgG is not a contraindication to renal transplantation: IgM may be beneficial to outcome.
abstract: BACKGROUND
  At our transplant center, primary recipients of either a haplo-identical (haplo-ID) living related (LRD) or a cadaveric (CAD) donor renal allograft are transplanted after a negative donor-specific IgG anti-human globulin (AHG) cross-match (XM). Testing included the historically highest panel-reactive antibody and the immediate (0-7 days) pretransplant sera. A positive donor specific IgM-AHG XM has not been a contraindication to transplant. Reports suggest that donor-specific flow cytometry cross-matches (FCXM) may be more clinically informative than the AHG-XM.
  
  
  METHODS
  We therefore evaluated the impact of a positive FCXM (IgG or IgM) on the rejection frequency (0-12 months after transplant) and 1-year graft survival for cyclosporine-prednisone-treated primary (haplo-ID and CAD) renal allograft recipients. All transplants were performed after a negative donor-specific IgG AHG-XM regardless of the IgM-AHG XM status.
  
  
  RESULTS
  Rejection frequencies (26% vs. 31%, P = NS) and 1-year graft survivals (92% vs. 89%, P = NS) were comparable for haplo-ID LRD FCXM-negative and IgG-FCXM-positive recipients. However, IgM-FCXM-positive LRD recipients experienced significantly fewer rejections (13% vs. 26% P<0.02) and an improved 1-year graft survival (100% vs. 92%, P<0.02) than FCXM-negative LRD recipients. Similar results were observed for primary CAD recipients. Rejection frequencies (40% vs. 44%, P = NS) and 1-year graft survivals (83% vs. 81%, P = NS) were comparable for primary CAD FCXM-negative and IgG-FCXM-positive recipients. Again, IgM-FCXM-positive primary CAD recipients experienced significantly fewer rejections (22% vs. 40%, P<0.02) and improved 1-year graft survivals (89% vs. 83%, P<0.05) than FCXM-negative recipients.
  
  
  CONCLUSIONS
  These data suggest that, after a negative donor-specific IgG-AHG XM, an IgG-positive FCXM is not a contraindication to transplantation. The presence of IgM may be beneficial in reducing the occurrence of rejection episodes and improving graft survivals.
authors.affiliation: Department of Surgery, University of Texas Medical School, Houston 77030, USA.
authors.forename: R H
authors.initials: RH
authors.lastname: Kerman
authors.forename: B
authors.initials: B
authors.lastname: Susskind
authors.forename: I
authors.initials: I
authors.lastname: Buyse
authors.forename: P
authors.initials: P
authors.lastname: Pryzbylowski
authors.forename: J
authors.initials: J
authors.lastname: Ruth
authors.forename: S
authors.initials: S
authors.lastname: Warnell
authors.forename: S A
authors.initials: SA
authors.lastname: Gruber
authors.forename: S
authors.initials: S
authors.lastname: Katz
authors.forename: C T
authors.initials: CT
authors.lastname: Van Buren
authors.forename: B D
authors.initials: BD
authors.lastname: Kahan
mesh_terms: D000075202:Contraindications; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D005434:Flow Cytometry; D005938:Glucocorticoids / Q000627:therapeutic use; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival; D006650:Histocompatibility Testing / Q000379:methods; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis*; D007075:Immunoglobulin M / Q000032:analysis; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D016030:Kidney Transplantation; D008297:Male; D011241:Prednisone / Q000627:therapeutic use; D013997:Time Factors; D014019:Tissue Donors
chemical_list: D005938:Glucocorticoids; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D011241:Prednisone