Multicenter evaluation of a novel endothelial cell crossmatch test in kidney transplantation.
BACKGROUND
Despite their clinical importance, clinical routine tests to detect anti-endothelial cell antibodies (AECA) in organ transplantation have not been readily available. This multicenter prospective kidney transplantation trial evaluates the efficacy of a novel endothelial cell crossmatch (ECXM) test to detect donor-reactive AECA associated with kidney allograft rejection.


METHODS
Pretransplant serum samples from 147 patients were tested for AECA by a novel flow cytometric crossmatch technique (XM-ONE) using peripheral blood endothelial progenitor cells as targets. Patient enrolment was based on acceptance for transplantation determined by donor lymphocyte crossmatch results.


RESULTS
Donor-reactive AECA were found in 35 of 147 (24%) patients. A significantly higher proportion of patients with a positive ECXM had rejections (16 of 35, 46%) during the follow-up of at least 3 months compared with those without AECA (13 of 112, 12%; P<0.00005). Both IgG and IgM AECAs were associated with graft rejections. Mean serum creatinine levels were significantly higher in patients with a positive ECXM test at 3 and 6 months posttransplant.


CONCLUSIONS
XM-ONE is quick, easy to perform on whole blood samples and identifies patients at risk for rejection and reduced graft function not identified by conventional lymphocyte crossmatches.
Breimer
Michael E
ME
Department of Surgery, Sahlgrenska Academy at Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden.
Rydberg
Lennart
L
Jackson
Annette M
AM
Lucas
Donna P
DP
Zachary
Andrea A
AA
Melancon
Joseph K
JK
Von Visger
Jon
J
Pelletier
Ronald
R
Saidman
Susan L
SL
Williams
Winfred W
WW
Holgersson
Jan
J
Tydén
Gunnar
G
Klintmalm
Göran K
GK
Coultrup
Sonnya
S
Sumitran-Holgersson
Suchitra
S
Grufman
Per
P
D004359:Drug Therapy, Combination; D004730:Endothelium, Vascular / Q000276:immunology* / Q000502:physiology; D005434:Flow Cytometry; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007518:Isoantibodies / Q000097:blood*; D016030:Kidney Transplantation / Q000276:immunology*; D042787:Receptor, TIE-2 / Q000032:analysis; D013548:Sweden; D014481:United States
D007166:Immunosuppressive Agents; D007518:Isoantibodies; D042787:Receptor, TIE-2