title: A prospective study evaluating the role of donor-specific anti-endothelial crossmatch (XM-ONE assay) in predicting living donor kidney transplant outcome.
abstract: Anti-endothelial cell antibodies (AECAs) may play a role in allograft rejection. We prospectively tested 150 consecutive living donor kidney transplant recipients, with transplants performed at Northwestern Memorial Hospital between January and December 2010, using the donor-specific endothelial (XM-ONE) crossmatch. 88/150 Patients received standard of care (SOC) immunosuppression and analyzed separately, in addition to the complete study cohort. Patients were followed for one year and XM-ONE results were analyzed in relation to occurrence of acute rejection, proteinuria, serum creatinine levels, and biopsy proven fibrosis. No correlation was found between XM-ONE results and protocol or "for-cause" biopsy proven acute rejection or vasculopathy at 12 months. When IgG+ and IgM+ results of the XM-ONE assay were combined, a correlation with proteinuria at 12 months was observed (p=0.047). Although IgG+XM-ONE results were associated with significantly higher creatinine at 6 months (p=0.018), significance was lost at 12 months. Conversely, patients with an IgM+XM-ONE crossmatch had significantly lower creatinine at 1 month (p=0.019), 3 months (p=0.0045), and 6 months (p=0.038) post-transplant, but lost statistical significance at 12 months (p=0.67) post-transplant. In summary, the presence of AECAs as determined by a positive XM-ONE result was not predictive of overall poorer graft outcome after one year in our center.
authors.affiliation: Transplant Immunology Laboratory, Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, 303 E Chicago Avenue, Tarry Building, Suite 11-703, Chicago, IL 60611, USA; Department of Surgery, Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, 251 East Huron Street, Galter 3-150, Chicago, IL 60611, USA. Electronic address: j-wehner@northwestern.edu.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Zitzner
authors.forename: Shivani
authors.initials: S
authors.lastname: Shah
authors.forename: Chunfa
authors.initials: C
authors.lastname: Jie
authors.forename: Wendy
authors.initials: W
authors.lastname: Wegner
authors.forename: Anat R
authors.initials: AR
authors.lastname: Tambur
authors.forename: John J
authors.initials: JJ
authors.lastname: Friedewald
mesh_terms: D000328:Adult; D042783:Endothelial Cells / Q000276:immunology / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D006650:Histocompatibility Testing / Q000706:statistics & numerical data; D006801:Humans; D007518:Isoantibodies / Q000097:blood; D007668:Kidney / Q000473:pathology* / Q000601:surgery; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D007518:Isoantibodies
keywords: AECAs; EPCs; ESRD; FSGS; HLA; MICA/MICB; SAB; SOC; UA; anti-endothelial cell antibodies; end stage renal disease; endothelial precursor cells; focal segmental glomerulosclerosis; human leukocyte antigen; major histocompatibility complex class I chain related antigen A and B; single antigen bead; standard of care; urinalysis