title: Renal Transplantation With Final Allocation Based on the Virtual Crossmatch.
abstract: Solid phase immunoassays (SPI) are now routinely used to detect HLA antibodies. However, the flow cytometric crossmatch (FCXM) remains the established method for assessing final donor-recipient compatibility. Since 2005 we have followed a protocol whereby the final allocation decision for renal transplantation is based on SPI (not the FCXM). Here we report long-term graft outcomes for 508 consecutive kidney transplants using this protocol. All recipients were negative for donor-specific antibody by SPI. Primary outcomes are graft survival and incidence of acute rejection within 1 year (AR <1 year) for FCXM+ (n = 54) and FCXM- (n = 454) recipients. Median follow-up is 7.1 years. FCXM+ recipients were significantly different from FCXM- recipients for the following risk factors: living donor (24% vs. 39%, p = 0.03), duration of dialysis (31.0 months vs. 13.5 months, p = 0.008), retransplants (17% vs. 7.3%, p = 0.04), % sensitized (63% vs. 19%, p = 0.001), and PRA >80% (20% vs. 4.8%, p = 0.001). Despite these differences, 5-year actual graft survival rates are 87% and 84%, respectively. AR <1 year occurred in 13% FCXM+ and 12% FCXM- recipients. Crossmatch status was not associated with graft outcomes in any univariate or multivariate model. Renal transplantation can be performed successfully, using SPI as the definitive test for donor-recipient compatibility.
authors.affiliation: Department of Surgery (Division of Transplantation), Medical College of Wisconsin, Milwaukee, WI.
authors.forename: C P
authors.initials: CP
authors.lastname: Johnson
authors.affiliation: Histocompatibility and Immunogenetics, Blood Center of Wisconsin, Milwaukee, WI.
authors.forename: J J
authors.initials: JJ
authors.lastname: Schiller
authors.affiliation: Department of Surgery (Division of Transplantation), Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Y R
authors.initials: YR
authors.lastname: Zhu
authors.affiliation: Department of Medicine (Division of Nephrology), Medical College of Wisconsin, Milwaukee, WI.
authors.forename: S
authors.initials: S
authors.lastname: Hariharan
authors.affiliation: Department of Surgery (Division of Transplantation), Medical College of Wisconsin, Milwaukee, WI.
authors.forename: A M
authors.initials: AM
authors.lastname: Roza
authors.affiliation: Department of Surgery (Division of Transplantation), Medical College of Wisconsin, Milwaukee, WI.
authors.forename: D C
authors.initials: DC
authors.lastname: Cronin
authors.affiliation: Department of Surgery (Division of Transplantation), Medical College of Wisconsin, Milwaukee, WI.
authors.forename: B D
authors.initials: BD
authors.lastname: Shames
authors.affiliation: Department of Surgery (Division of Transplantation), Medical College of Wisconsin, Milwaukee, WI.
authors.forename: T M
authors.initials: TM
authors.lastname: Ellis
mesh_terms: D001402:B-Lymphocytes / Q000276:immunology; D001788:Blood Grouping and Crossmatching; D005260:Female; D005434:Flow Cytometry / Q000379:methods; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis* / Q000517:prevention & control; D006085:Graft Survival; D015276:Health Care Rationing / Q000379:methods*; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D007518:Isoantibodies / Q000276:immunology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement
chemical_list: D007518:Isoantibodies