Positive remote crossmatch: impact on short-term and long-term outcome in cadaver renal transplantation.
BACKGROUND
A positive crossmatch with a "current" recipient serum (drawn shortly before the proposed transplant) is a contraindication to renal transplantation because of the risk of hyperacute rejection. Conflicting data have been reported concerning the significance of a positive crossmatch with "remote" sera (obtained months or years earlier) when the current crossmatch is negative.


METHODS
Recipients of a first or second cadaver transplant between June 1988 and April 1994 were studied. All transplants were performed with a negative "current" crossmatch. Retrospective crossmatches using "remote" sera were performed for all sensitized recipients.


RESULTS
Recipients with a positive remote crossmatch (RXM) demonstrated a higher incidence of delayed graft function and of acute rejection and graft loss occurring in the first year posttransplant than did sensitized recipients with a negative RXM or unsensitized recipients. In multivariate analysis, only recipients with both a positive RXM and delayed graft function were at significantly higher risk for graft loss. Grafts surviving the first year demonstrated similar half-lives whether the RXM was positive or negative.


CONCLUSIONS
The positive RXM, possibly in conjunction with other factors leading to very early graft damage, is a significant predictor of unfavorable transplant outcome in first and second renal transplants. This effect is seen early in the transplant course, and there seems to be no impact on outcome after the first year. Newer immunosuppressive modalities may help to reduce the early negative impact.
Noreen
Harriet J
HJ
Fairview-University Medical Center, Minneapolis, MN, USA.
McKinley
Devin M
DM
Gillingham
Kristen J
KJ
Matas
Arthur J
AJ
Segall
Miriam
M
D000208:Acute Disease; D002102:Cadaver; D002908:Chronic Disease; D006084:Graft Rejection / Q000401:mortality*; D006085:Graft Survival; D006650:Histocompatibility Testing / Q000592:standards*; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality*; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome