title: B-cell complement dependent cytotoxic crossmatch positivity is an independent risk factor for long-term renal allograft survival.
abstract: The clinical significance of positive B-cell complement-dependent cytotoxicity crossmatching (B-CDC) in renal transplant recipients remains unclear. We reviewed 20 recipients with isolated B-CDC positivity at the time of transplantation. We compared the clinical characteristics, acute rejection and long-term graft survival between positive and negative B-CDC patients (n = 602). The number of retransplant recipients and positivity for T- and B-flowcytometric crossmatch was greater in positive B-CDC patients than in negative B-CDC patients. The overall acute rejection rate of positive B-CDC patients was significantly higher (P < 0.001), and Banff grade II or III cellular rejection was more frequently observed in positive B-CDC patients (P = 0.037). Compared with negative B-CDC patients, acute cellular rejection as a cause of graft loss was more prevalent (P = 0.020) and rescue rejection therapy was more frequently needed in positive B-CDC patients (P = 0.007). The allograft survival rate of positive B-CDC patients was significantly lower than that of negative B-CDC patients (P < 0.001), and B-CDC positivity independently increased the risk of allograft failure 2.31-fold (95% CI 1.15-4.67; P = 0.019) according to multivariate analysis. In conclusion, isolated B-CDC positivity is an independent long-term prognostic factor for allograft survival.
authors.affiliation: Transplantation Research Center, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea.
authors.forename: Hyeon Seok
authors.initials: HS
authors.lastname: Hwang
authors.forename: Hye Eun
authors.initials: HE
authors.lastname: Yoon
authors.forename: Bum Soon
authors.initials: BS
authors.lastname: Choi
authors.forename: Eun Jee
authors.initials: EJ
authors.lastname: Oh
authors.forename: Ji Il
authors.initials: JI
authors.lastname: Kim
authors.forename: In Sung
authors.initials: IS
authors.lastname: Moon
authors.forename: Yong Soo
authors.initials: YS
authors.lastname: Kim
authors.forename: Chul Woo
authors.initials: CW
authors.lastname: Yang
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001402:B-Lymphocytes / Q000276:immunology*; D003167:Complement Activation; D003601:Cytotoxicity Tests, Immunologic; D005260:Female; D006085:Graft Survival / Q000276:immunology*; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013601:T-Lymphocytes / Q000276:immunology; D014184:Transplantation, Homologous