Utility of virtual crossmatch in sensitized patients awaiting heart transplantation.
BACKGROUND
Organ transplant candidates with serum antibodies directed against human leukocyte antigens (HLA) face longer waiting times and higher mortality while awaiting transplantation. This study examined the accuracy of virtual crossmatch, in which recipient HLA-specific antibodies, identified by solid-phase assays, are compared to the prospective donor HLA-type in heart transplantation.


METHODS
We examined the accuracy of virtual crossmatch in predicting immune compatibility of donors and recipients in heart transplantation and clinical outcomes in immunologically sensitized heart transplant recipients in whom virtual crossmatch was used in allograft allocation.


RESULTS
Based on analysis of 257 T-cell antihuman immunoglobulin complement-dependent cytotoxic (AHG-CDC) crossmatch tests, the positive predictive value of virtual crossmatch (the likelihood of an incompatible virtual crossmatch resulting in an incompatible T-cell CDC-AHG crossmatch) was 79%, and the negative predictive value of virtual crossmatch (the likelihood of a compatible virtual crossmatch resulting in a compatible T-cell CDC-AHG crossmatch) was 92%. When used in a cohort of 28 sensitized patients awaiting heart transplantation, 14 received allografts based on a compatible virtual crossmatch alone from donors in geographically distant locations. Compared with the other 14 sensitized patients who underwent transplant after a compatible prospective serologic crossmatch, the rejection rates and survival were similar.


CONCLUSIONS
Our findings are evidence of the accuracy of virtual crossmatch and its utility in augmenting the opportunities for transplantation of sensitized patients.
Stehlik
Josef
J
U.T.A.H. Cardiac Transplant Program, University of Utah Hospital, and VA Salt Lake City Health Care System-Cardiology Section, 500 Foothill Blvd., Salt Lake City, UT 84148, USA. josef.stehlik@hsc.utah.edu
Islam
Nauman
N
Hurst
Denise
D
Kfoury
Abdallah G
AG
Movsesian
Matthew A
MA
Fuller
Ann
A
Delgado
Julio C
JC
Hammond
M Elizabeth H
ME
Gilbert
Edward M
EM
Renlund
Dale G
DG
Bader
Feras
F
Fisher
Patrick W
PW
Bull
David A
DA
Singhal
Arun K
AK
Eckels
David D
DD
D015415:Biomarkers / Q000097:blood; D004719:Endomyocardial Fibrosis / Q000453:epidemiology / Q000401:mortality; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000276:immunology*; D006650:Histocompatibility Testing / Q000379:methods; D006801:Humans; D051795:Hypoxia-Inducible Factor 1, alpha Subunit / Q000097:blood; D011183:Postoperative Complications / Q000453:epidemiology / Q000276:immunology / Q000401:mortality / Q000517:prevention & control; D011393:Procollagen-Proline Dioxygenase / Q000097:blood; D013997:Time Factors; D014584:User-Computer Interface; D042461:Vascular Endothelial Growth Factor A / Q000097:blood
D015415:Biomarkers; C497442:HIF1A protein, human; D051795:Hypoxia-Inducible Factor 1, alpha Subunit; D042461:Vascular Endothelial Growth Factor A; D011393:Procollagen-Proline Dioxygenase