Repository for Antibody Incompatible Transplantation Evidence

The significance of a positive flow cytometry crossmatch test in primary kidney transplantation.

Transplantation. 1993 Aug;56(2):294-8 doi: 10.1097/00007890-199308000-00007.

This study was conducted to determine the efficacy of the T cell flow cytometry crossmatch (T-FCXM) test in 841 first cadaver donor transplants. Results showed one-year graft survival rates were 82% for T-FCXM-negative patients, compared with 75% for T-FCXM-positive patients (P = 0.01). Early one-month graft failure was 13 percentage points higher in those with a positive T-FCXM than those with a negative T-FCXM. The positive crossmatch patients also had more frequent immunological failures. A positive T-FCXM was found in 39% of the sensitized patients (PRA > 10%) and 8% of those who had not been sensitized. Patients with a positive T-FCXM in either category had a 74% graft survival rate. Thus, most of the T-FCXM-positive results occurred in patients with complement-fixing antibodies. It is suggested that flow cytometry crossmatching (FCXM) be used prospectively, despite the fact that many patients with a positive crossmatch did have successful transplants (TXs). In the current climate of a cadaver kidney scarcity and large recipient waiting pools, utilization of kidneys for patients with the highest probability of success seems a most prudent policy.

LEVEL OF EVIDENCE: Case Series / Case Control / Cohort
MESH HEADINGS: Antibodies / immunology; B-Lymphocytes / immunology; Female; Flow Cytometry*; Graft Rejection / immunology; Histocompatibility Testing / methods*; Humans; Kidney Transplantation / immunology*; Male; Predictive Value of Tests; Retrospective Studies; T-Lymphocytes / immunology; Tissue Donors*