The relevance of donor T cell-directed immunoglobulin G in historic sera in the age of flow cytometry.
BACKGROUND
Renal transplant recipients with a positive historic cross-match due to donor T cell-directed IgG antibodies are considered to have decreased graft survival, even if their current serum is negative prior to transplantation. With the use of flow cytometric cross-match for testing current sera, false-negative results could be eliminated and the outcome of transplantation in this group of patients could be improved, assuming that immunological memory is effectively controlled with immunosuppression.


METHODS
We reviewed our records to identify those patients who underwent cadaveric renal transplant, with a historic IgG positive cytotoxic T cell cross-match and a current negative flow cytometric T cell cross-match.


RESULTS
Eighteen patients underwent cadaveric renal transplant in the face of a historic IgG positive T cell cross-match and a current negative flow cytometric T cell cross-match. In 14 patients treated with cyclosporine-based immunosuppression the 1-, 2-, and 3-year cumulative graft survival rates were 57, 50, and 43%, respectively. Ten of the 14 patients (71%) ultimately lost their grafts.


CONCLUSIONS
Even with negative flow cytometric cross-match in current serum, a positive historic conventional cross-match suggests a high risk of graft failure.
Avlonitis
V S
VS
Department of Liver and Renal Transplantation, Freeman Hospital, Newcastle upon Tyne, UK.
Chidambaram
V
V
Manas
D M
DM
Cavanagh
G
G
Carter
V
V
Talbot
D
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D002102:Cadaver; D002648:Child; D002675:Child, Preschool; D005260:Female; D005434:Flow Cytometry; D006650:Histocompatibility Testing; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D007668:Kidney; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D013601:T-Lymphocytes / Q000276:immunology*; D013997:Time Factors; D014019:Tissue Donors
D007074:Immunoglobulin G