title: Living-donor kidney transplant in T-cell and B-cell flow cytometry crossmatch-positive patients.
abstract: OBJECTIVE
  Complement-dependent cytotoxic crossmatch is an important indicator for kidney transplant. However, there is controversy about treatment for flow cytometry crossmatch-positive cases.
  
  
  METHODS
  This was a retrospective study of 127 living-donor kidney transplant recipients from May 2007 to July 2011. We divided patients into 115 flow cytometry crossmatch T-cell and B-cell-negative cases, and 12 T-cell and B-cell-positive cases. Both groups were given 20 mg basiliximab the day of surgery and 4 days after surgery. Common oral immunosuppressive agents used were tacrolimus, mycophenolate mofetil, and methylprednisolone. Flow cytometry crossmatch T-cell and B-cell-negative recipients started immunosuppression 7 days before surgery, T-cell and B-cell-positive recipients started immunosuppression 14 days before surgery. T-cell and B-cell-positive patients also received 200 mg rituximab 1 week before surgery, had 3 plasma exchange sessions before transplant, and received intravenous immunoglobulin 20 g/day during surgery and after surgery for 5 days. We measured flow-panel reactive antibodies of T-cell and B-cell-positive patients just before surgery to check desensitization efficiency. We evaluated patient survival, graft survival, graft function, and frequency of rejection and infectious diseases.
  
  
  RESULTS
  Patient survival and graft survival were 100% in both groups. Flow cytometry crossmatch T-cell and B-cell-positive cases had no rejection events, but T-cell and B-cell-negative groups developed rejection. There was no statistical difference in the incidence of infection and graft function. Flow-panel reactive antibody demonstrated improvement in all T-cell and B-cell-positive cases.
  
  
  CONCLUSIONS
  In living-donor kidney transplant, flow cytometry crossmatch T-cell and B-cell-positive patients are still considered to be at high risk. Although this is a short-term outcome, all T-cell and B-cell-positive patients in this study achieved excellent results with appropriate preoperative and postoperative treatment.
authors.affiliation: Department of Surgery and Oncology, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan.
authors.forename: Soushi
authors.initials: S
authors.lastname: Terasaka
authors.forename: Hidehisa
authors.initials: H
authors.lastname: Kitada
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Okabe
authors.forename: Sayako
authors.initials: S
authors.lastname: Kawanami
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Noguchi
authors.forename: Kyoko
authors.initials: K
authors.lastname: Miyamoto
authors.forename: Akihiro
authors.initials: A
authors.lastname: Tsuchimoto
authors.forename: Kousuke
authors.initials: K
authors.lastname: Masutani
authors.forename: Masao
authors.initials: M
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D000906:Antibodies / Q000097:blood*; D001402:B-Lymphocytes / Q000187:drug effects / Q000276:immunology*; D015415:Biomarkers / Q000097:blood; D003141:Communicable Diseases / Q000276:immunology; D003888:Desensitization, Immunologic / Q000379:methods; D005260:Female; D005434:Flow Cytometry; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival / Q000187:drug effects; D006648:Histocompatibility / Q000187:drug effects; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013601:T-Lymphocytes / Q000187:drug effects / Q000276:immunology*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000906:Antibodies; D015415:Biomarkers; D007166:Immunosuppressive Agents