The clinical significance of conversion of complement-dependent cytotoxic T cell crossmatch test after renal transplantation.
The purpose of this study was to investigate the clinical relevance of conversion of post-transplant T cell crossmatch between kidney donor and recipient. This study comprises 892 cadaveric renal transplantations performed on 874 adult patients between August 1991 and December 1997. Recipient selection was based on a negative complement-dependent cytotoxic T cell crossmatch test with current (< or = 2 months old) serum. For this study, on day 0 and day 14 after transplantation, serum samples were collected for later crossmatching. On day 14 after transplantation, the crossmatch had converted to positive in 76 transplantations (8.5%). Acute rejection occurred in 50% of the converters and 22% of the non-converters (P < 0.005), and graft survival was significantly poorer (P < 0.025), being 85 vs 94% at 1 and 68 vs 83% at 5 years, respectively. In patients with delayed graft function, 1-year graft survival was 77% in the converters and 91% in the non-converters (P < 0.05). Conversion of T cell crossmatch, especially in connection with delayed graft function, identifies a subgroup of patients at high risk of severe rejection and poor graft survival.
Kyllönen
L E
LE
Department of Surgery, Helsinki University Central Hospital, Finland. lauri.kyllonen@huch.fi
Salmela
K T
KT
Koskimies
S A
SA
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D003165:Complement System Proteins / Q000276:immunology*; D005260:Female; D006084:Graft Rejection / Q000276:immunology*; D006085:Graft Survival; D006650:Histocompatibility Testing; D006801:Humans; D007518:Isoantibodies / Q000096:biosynthesis; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012306:Risk; D013602:T-Lymphocytes, Cytotoxic / Q000276:immunology*; D014184:Transplantation, Homologous / Q000276:immunology; D016896:Treatment Outcome
D007518:Isoantibodies; D003165:Complement System Proteins