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Clinical significance of a positive flow crossmatch on the outcomes of cadaveric renal transplants

Ilham, M. A., Winkler, S., Coates, E., Rizzello, A., Rees, T. J. and Asderakis, A. ORCID: 2008. Clinical significance of a positive flow crossmatch on the outcomes of cadaveric renal transplants. Transplantation Proceedings 40 (6) , pp. 1839-1843. 10.1016/j.transproceed.2008.05.009

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Pretransplantation crossmatching is an integral part of kidney transplantation. Flow cytometric crossmatch (FCXM) is more sensitive than complement-dependent cytotoxic crossmatch (CDC-XM). However, the clinical significance of positive FCXM with negative CDC-XM is controversial. We evaluated FCXM in 455 consecutive deceased donor renal transplants. All had a negative CDC-XM. There were 341 T-cell and B-cell FCXM negative and 38 T-cell and B-cell positive. There was a higher percentage of retransplantations and HLA mismatches (26.3% vs 8.2%, P = .002 and 2.45 vs 1.99, P = .02, respectively) in the FCXM-positive group compared with the FCXM-negative group; 65.8% of the FCXM-positive patients had rejection compared with 49.3% of the FCXM-negative patients (odds ratio [OR] = 1.89, P = .06). FCXM-positive patients had a higher incidence of vascular rejection (28.9% vs 12.6%, OR = 2.68, P = .008). One- and 5-year graft survivals were 84% and 66% in the FCXM-positive group vs 90% and 75% in the FCXM-negative group. Censoring for patient death, 1- and 5-year graft survivals were 84% and 73% in the FCXM-positive group vs 94% and 82% in the FCXM-negative group. There was no difference in renal function between the 2 groups. In conclusion, a positive T-cell and B-cell FCXM transplant with a negative CDC-XM is associated with a higher incidence of rejection, twice the risk of vascular rejection, and a trend toward poorer graft survival.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > R Medicine (General)
Publisher: Elsevier
ISSN: 0041-1345
Last Modified: 28 Oct 2022 10:12

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