title: Solid phase-based cross-matching as solution for kidney allograft recipients pretreated with therapeutic antibodies.
abstract: In order to select recipients without donor-specific anti-HLA antibodies, the complement-dependent cytotoxicity crossmatch (CDC-CM) was established as the standard procedure about 40 years ago. However, the interpretability of this functional assay strongly depends on the vitality of isolated donors' lymphocytes. Since the application of therapeutic antibodies for the immunosuppressive regimen falsifies the outcome of the CDC-crossmatch as a result of these antibodies' complement-activating capacity in the recipients' sera, we looked for an alternative methodical approach. We here present 27 examples of AB0 blood group-incompatible living kidney allograft recipients who, due to their treatment with the humanized chimeric monoclonal anti-CD20 antibody Rituximab, did not present valid outcomes of CDC-based pretransplant cross-matching. Additionally, four cases of posttransplant cross-matching after living kidney allografting and consequent treatment with the therapeutic anti-CD25 antibody Basiliximab (Simulect) due to acute biopsy-proven rejection episodes are presented and compared regarding CDC- and ELISA-based crossmatch outcomes. In all cases, it became evident that the classical CDC-based crossmatch was completely unfeasible for the detection of donor-specific anti-HLA antibodies, whereas ELISA-based cross-matching not requiring vital cells was not artificially affected. We conclude that ELISA-based cross-matching is a valuable tool to methodically circumvent false positive CDC-based crossmatch results in the presence of therapeutically applied antibodies.
authors: Tissue Typing Laboratory, University Hospital Halle (Saale), 06112 Halle (Saale), Germany.
authors: Gerald
authors: 0000-0001-7158-6043
authors: G
authors: Schlaf
authors: Tissue Typing Laboratory, University Hospital Halle (Saale), 06112 Halle (Saale), Germany.
authors: Susanne
authors: 0000-0001-7777-8433
authors: S
authors: Apel
authors: Tissue Typing Laboratory, University Hospital Halle (Saale), 06112 Halle (Saale), Germany.
authors: Anja
authors: A
authors: Wahle
authors: Tissue Typing Laboratory, University Hospital Halle (Saale), 06112 Halle (Saale), Germany.
authors: Wolfgang W
authors: WW
authors: Altermann
mesh_terms: D064591:Allografts / Q000276:immunology*; D000906:Antibodies / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000077552:Basiliximab; D003165:Complement System Proteins / Q000276:immunology; D003602:Cytotoxicity, Immunologic; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods*; D006680:HLA Antigens / Q000276:immunology; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D016030:Kidney Transplantation; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D000069283:Rituximab; D014019:Tissue Donors
chemical_list: D000906:Antibodies; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D006680:HLA Antigens; D011993:Recombinant Fusion Proteins; D000069283:Rituximab; D003165:Complement System Proteins; D000077552:Basiliximab
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