03 February 2019 : Clinical Research
Comparison of Physical Crossmatch and Virtual Crossmatch to Identify Preexisting Donor-Specific Human Leukocyte Antigen (HLA) Antibodies and Outcome Following Kidney TransplantationBo Peng12ABCDEF, Quan Zhuang12ADEG, Meng Yu12BC, Junhui Li12CD, Yun Liu12BC, Lijun Zhu12BC, Yingzi Ming12AG*
Med Sci Monit 2019; 25:952-961
BACKGROUND: Physical crossmatch (PXM) and virtual crossmatch (VXM) are applied to identify preexisting donor-specific human leukocyte antigen (HLA) antibodies in patients awaiting kidney transplantation. Recently, high-resolution epitope analysis has emerged as a novel strategy for VXM. A retrospective clinical study compared PXM with VXM before kidney transplantation and recipient outcome following transplantation.
MATERIAL AND METHODS: Between August 2017 and March 2018, 239 patients underwent crossmatching and 94 patients received a donor kidney. A complement-dependent cytotoxicity (CDC) PXM assay and VXM using serological and epitope analysis identified donor-specific antibodies (DSA). Crossmatch results and clinical outcome at 3 months were compared.
RESULTS: VXM identified serological DSA (sDSA), verified epitope DSA, and total epitope DSA in 74 (31.0%), 39 (16.3%), and 49 (20.5%) cases, respectively. Eleven cases (4.6%) had a positive PXM detected by the CDC assay. Of 94 kidney transplant recipients, 21 had preexisting sDSA but were negative in PXM; there was 1 case of delayed graft function (DGF) and no cases of hyperacute rejection or acute rejection. Of the rest of the 73 recipients who were negative for sDSA, 8 had acute rejection (P=0.253) and 19 had DGF (P=0.037). No significant differences were found in graft survival at 3 months.
CONCLUSIONS: High-resolution epitope analysis identified fewer cases with DSA compared with serological analysis. Because patients with and without sDSA had a similar short-term outcome in the setting of a negative PXM, the presence of preexisting sDSA, determined by VXM, should not be an absolute contraindication for kidney transplantation.
Keywords: Cytotoxicity Tests, Immunologic, Epitopes, Histocompatibility Testing, Kidney Transplantation, Antibodies, Blood Grouping and Crossmatching, Graft Rejection, Graft Survival, HLA Antigens, Histocompatibility Antigens Class I, Middle Aged, Retrospective Studies, Tissue Donors
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