Long-term kidney graft survival across a positive historic but negative current sensitized cross-match.
BACKGROUND
The sensitive cross-match (XM) techniques that have been introduced for clinical transplantation can detect anti-donor immune reactivity despite a negative standard National Institute of Health (NIH) cross-match. One of them uses anti-kappa human light chain globulins (AHG). But there is some discussion about the clinical consequences of a positive AHG-XM in the historical sera that became negative in the sera collected just before the transplantation (pretransplant sera). This study was intended to assess the risk of kidney graft failure associated with a positive historic but negative pretransplant AHG-XM in allosensitized patients having a negative historic NIH-XM.


METHODS
This retrospective study includes 90 consecutive renal transplants in immunized patients performed at one center between 1985 and 1991. All of the patients had negative historical and pretransplant standard NIH lymphocytotoxic cross-matches and received the same immunosuppressive regimen. The AHG-XMs were done retrospectively using peak historic and sera collected on the day of the transplantation.


RESULTS
The AHG cross-match (AHG-XM) was positive in 17 patients, although the standard NIH cross-match was negative. Fourteen of them had a positive historical but negative pretransplant AHG-XM. The actuarial graft survival in this group of 14 patients was 100% at 1 year and 78% at 9 years compared with 90 and 67%, respectively, in patients with negative historical AHG-XM. In addition, the number of rejection episodes per patient as well as renal function at 1, 2, and 5 years were similar in the two groups. IgG anti-donor HLA class I accounted for the XM positivity in 12 of the 14 patients; most rapidly lost all antibody reactivity by NIH technique in an average time of 8 months before the transplantation. In conclusion, this study suggests that transplant patients having a negative historic NIH-XM but a positive historic AHG-XM may not be at high risk of graft failure especially if there is a well-documented sera history showing a marked decrease in PRA level before transplantation and a negative pretransplant AHG-XM.
Baron
Christophe
C
Transplantation Biology Research Center, Massachusetts General Hospital, Boston, USA.
Pastural
Myriam
M
Lang
Philippe
P
Bentabet
Radia
R
el-Kassar
Nahed
N
Seror
Thérèse
T
Dahmane
Djamel
D
Desvaux
Dominique
D
Chopin
Dominique
D
Fruchaud
Ghislaine
G
Remy
Philippe
P
Grimbert
Philippe
P
Lepage
Eric
E
Bierling
Philippe
P
D000328:Adult; D005260:Female; D006085:Graft Survival; D006650:Histocompatibility Testing; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology; D007147:Immunoglobulin Light Chains / Q000276:immunology; D007518:Isoantibodies / Q000032:analysis; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged
D007074:Immunoglobulin G; D007147:Immunoglobulin Light Chains; D007518:Isoantibodies