Immunoglobulin G-positive in B-cell cross-match decreases kidney allograft survival.
We retrospectively studied all 1149 transplants performed at our center between 1993 and 2003 to determine the incidence and clinical effect of pretransplant B-positive cross-match on kidney graft survival. The patients were divided in two groups: B-negative (n = 1102) and B-positive in current sera (n = 47; 4.1%). AB-positive test was more frequent among regrafted patients (14% vs 3%; P = .00). Demographic data were not different between the groups. The overall rate of graft loss was similar (26% vs 24%, respectively; P = .86). However, early nonsurgical graft losses were more frequent among B-positive patients (46% vs 20%, respectively; P = .04). IgM was the most frequent immunoglobulin in the B-positive group (76% IgM and 24% IgG). There was no significant difference between B-negative and B-positive groups in the 1-, 5-, and 10-year graft survival rates (87% vs 83%, 73% vs 78%, 64% vs 66%, respectively; P = .87). The graft survival was significantly reduced comparing an IgG anti-B cell to the B-negative group (P = .03) as well as IgG compared to IgM (P = .004). In conclusion, only B-positive cross-match due to IgG decreased graft survival. Even though it is an uncommon situation (0.9%), this study stressed the clinical value of the B-cell cross-match as a tool to identify patients with a higher immunological risk.
Fagundes
I
I
Transplant Immunology Laboratory, Santa Casa Hospital, Porto Alegre, Brasil. f_iara@santacasa.tche.br
Michelon
T
T
Schoroeder
R
R
Fernandes
S
S
Sporleder
H
H
Canabarro
R
R
Rodrigues
H
H
Petry
M
M
Zanenga
D
D
Silveira
J
J
Montagner
J
J
Bortolotto
A
A
Keitel
E
E
Santos
A
A
Garcia
V
V
Neumann
J
J
D001402:B-Lymphocytes / Q000276:immunology*; D001789:Blood Group Antigens / Q000032:analysis; D006085:Graft Survival / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis*; D007132:Immunoglobulin Isotypes / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D016030:Kidney Transplantation / Q000276:immunology*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D001789:Blood Group Antigens; D007074:Immunoglobulin G; D007132:Immunoglobulin Isotypes; D007075:Immunoglobulin M