title: Immunoglobulin G-positive in B-cell cross-match decreases kidney allograft survival.
abstract: 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.
authors.affiliation: Transplant Immunology Laboratory, Santa Casa Hospital, Porto Alegre, Brasil. f_iara@santacasa.tche.br
authors.forename: I
authors.initials: I
authors.lastname: Fagundes
authors.forename: T
authors.initials: T
authors.lastname: Michelon
authors.forename: R
authors.initials: R
authors.lastname: Schoroeder
authors.forename: S
authors.initials: S
authors.lastname: Fernandes
authors.forename: H
authors.initials: H
authors.lastname: Sporleder
authors.forename: R
authors.initials: R
authors.lastname: Canabarro
authors.forename: H
authors.initials: H
authors.lastname: Rodrigues
authors.forename: M
authors.initials: M
authors.lastname: Petry
authors.forename: D
authors.initials: D
authors.lastname: Zanenga
authors.forename: J
authors.initials: J
authors.lastname: Silveira
authors.forename: J
authors.initials: J
authors.lastname: Montagner
authors.forename: A
authors.initials: A
authors.lastname: Bortolotto
authors.forename: E
authors.initials: E
authors.lastname: Keitel
authors.forename: A
authors.initials: A
authors.lastname: Santos
authors.forename: V
authors.initials: V
authors.lastname: Garcia
authors.forename: J
authors.initials: J
authors.lastname: Neumann
mesh_terms: 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
chemical_list: D001789:Blood Group Antigens; D007074:Immunoglobulin G; D007132:Immunoglobulin Isotypes; D007075:Immunoglobulin M