Positive B-cell only flow cytometric crossmatch: implications for renal transplantation.
In renal transplantation, the presence of anti-donor HLA antibodies is associated with early rejection and accelerated graft loss. The clinical relevance of anti-HLA antibodies can be evaluated in the crossmatch assay using either a complement-dependent cytotoxicity (CDC) assay or a flow cytometric crossmatch (FCXM) method. The FCXM technique is more sensitive than CDC-based assays for detection of anti-donor antibodies and allows the simultaneous detection of antibodies against T-lymphocytes (anti-HLA class I antibodies) and B-lymphocytes (anti-HLA class I and/or HLA class II antibodies). Although the clinical relevance of a positive FCXM using T-lymphocytes in kidney graft outcome is well established, there is still debate about the clinical significance of a positive B-cell only FCXM (B+FCXM). In this review we discuss several factors to consider during the evaluation of patients with a B+FCXM and suggest ideas to improve the use of the information provided by the FCXM assay.
Delgado
Julio C
JC
Division of Clinical Pathology, Department of Pathology, University of Utah School of Medicine, 15 North Medical Drive East, Salt Lake City, UT 84112, USA. julio.delgado@path.utah.edu
Eckels
David D
DD
D000906:Antibodies / Q000032:analysis*; D001402:B-Lymphocytes / Q000276:immunology*; D005434:Flow Cytometry / Q000379:methods* / Q000592:standards; D006680:HLA Antigens / Q000276:immunology*; D006650:Histocompatibility Testing / Q000379:methods* / Q000592:standards; D006801:Humans; D016030:Kidney Transplantation; D012680:Sensitivity and Specificity; D014019:Tissue Donors
D000906:Antibodies; D006680:HLA Antigens