title: Flow cytometry crossmatching as a predictor of acute rejection in sensitized recipients of cadaveric renal transplants.
abstract: 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.
authors.affiliation: Department of Transplantation Surgery, University of California, San Francisco 94143, USA.
authors.forename: R W
authors.initials: RW
authors.lastname: O'Rourke
authors.forename: R W
authors.initials: RW
authors.lastname: Osorio
authors.forename: C E
authors.initials: CE
authors.lastname: Freise
authors.forename: C D
authors.initials: CD
authors.lastname: Lou
authors.forename: M R
authors.initials: MR
authors.lastname: Garovoy
authors.forename: P
authors.initials: P
authors.lastname: Bacchetti
authors.forename: N L
authors.initials: NL
authors.lastname: Ascher
authors.forename: J S
authors.initials: JS
authors.lastname: Melzer
authors.forename: J P
authors.initials: JP
authors.lastname: Roberts
authors.forename: P G
authors.initials: PG
authors.lastname: Stock
mesh_terms: 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
chemical_list: D000906:Antibodies; D006680:HLA Antigens; D003165:Complement System Proteins; D003404:Creatinine