Flow cytometry crossmatching as a predictor of acute rejection in sensitized recipients of cadaveric renal transplants.
Flow cytometry crossmatching (FCXM) was developed as a more sensitive assay than the standard complement-dependent cytotoxicity crossmatch (CDCXM) for the detection of anti-donor antibodies, that mediate hyperacute rejection and graft loss in the early post-transplant period in renal transplant recipients. The role of FCXM in predicting long-term clinical outcome in renal allograft recipients is unclear. This study examines the role of FCXM in predicting long-term clinical outcome in highly sensitized recipients of cadaveric renal transplants. All patients (n = 100) with peak panel reactive antibody (PRA) levels > 30%, who received cadaveric renal transplants between 1/1/'90 and 12/31/'95 at our institution, were divided into FCXM + and FCXM - groups. The incidence of acute rejection was determined for each group during the first yr after transplant. Graft survival rates at 1, 2, and 3 yr, and creatinine levels were also compared between groups. FCXM + patients experienced a higher incidence of acute rejection during the first yr after transplant (69 vs. 45%), and a higher percentage of FCXM + patients had more than one episode of acute rejection during the first yr after transplant (34 vs. 8%) when compared to FCXM - patients. There was no statistically significant difference in 1-, 2-, or 3-yr graft survival between FCXM + and FCXM - patients (76 vs. 83, 62 vs. 80, 62 vs. 72%, respectively). These results suggest that sensitized FCXM + cadaveric renal transplant recipients have a higher incidence of acute rejection episodes in the first yr after transplant. Given the association of multiple rejection episodes with poor long-term allograft survival, FCXM may be a useful predictor of long-term clinical outcome in this sub-group of renal transplant recipients.
O'Rourke
R W
RW
Department of Transplantation Surgery, University of California, San Francisco 94143, USA.
Osorio
R W
RW
Freise
C E
CE
Lou
C D
CD
Garovoy
M R
MR
Bacchetti
P
P
Ascher
N L
NL
Melzer
J S
JS
Roberts
J P
JP
Stock
P G
PG
D000208:Acute Disease; D000328:Adult; D000906:Antibodies / Q000276:immunology; D002102:Cadaver; D003165:Complement System Proteins / Q000032:analysis; D003404:Creatinine / Q000097:blood; D003602:Cytotoxicity, Immunologic / Q000276:immunology; D005260:Female; D005434:Flow Cytometry; D005500:Follow-Up Studies; D005544:Forecasting; D006084:Graft Rejection / Q000209:etiology*; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D007114:Immunization; D015994:Incidence; D016030:Kidney Transplantation / Q000276:immunology*; D016015:Logistic Models; D008297:Male; D011237:Predictive Value of Tests; D018709:Statistics, Nonparametric; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D000906:Antibodies; D006680:HLA Antigens; D003165:Complement System Proteins; D003404:Creatinine