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Improved Graft Survival in Cadaveric Renal Retransplantation by Flow Crossmatching
Paul W. Nelson, MD;
Patty Eschliman;
Charles F. Shield, MD;
Mark I. Aeder, MD;
Alan M. Luger, MD;
George E. Pierce, MD;
Christopher F. Bryan, PhD
Arch Surg. 1996;131(6):599-603.
Abstract
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Objective
To evaluate the role of flow cytometry crossmatching on graft survival in patients undergoing cadaveric renal retransplantation compared with our conventional antihuman globulin cytotoxic crossmatch.
Design
In 1990, 6 of 7 transplantation centers in 1 organ procurement organization service area began performing cadaveric renal retransplantation only if the flow T-cell IgG crossmatch was negative. During that period, 1 center continued to use only the antihuman globulin T-cell IgG crossmatch. Prior to 1990, all centers used only the antihuman globulin T-cell IgG crossmatch as their crossmatch selection criterion for retransplantation. Regraft survival was compared between those centers by crossmatch selection criteria.
Patients
Patient selection and immunosuppression decisions were made at the transplantation center.
Setting
All flow cytometry crossmatches for all 7 centers participating in the evaluation were performed at the Histocompatibility Laboratory of the Midwest Organ Bank Inc, Westwood, Kan.
Results
Graft survival is significantly better (P=.03 [logrank test]) in regrafts when the flow crossmatch is used to select patients for transplantation.
Conclusion
Flow crossmatching improves graft survival in cadaveric renal retransplantation by identifying a subset of patients with donor-directed HLA class I antibodies that are not detectable by our conventional antihuman globulin crossmatch.
(Arch Surg. 1996;131:599-603)
Author Affiliations
From the Midwest Organ Bank Inc, Westwood, Kan (Drs Nelson and Bryan and Ms Eschliman); St Francis Medical Center, Wichita, Kan (Dr Shield); Research Medical Center, Kansas City, Mo (Dr Aeder); the Department of Pathology, University of Missouri-Columbia (Dr Luger); the Departments of Surgery, the University of Missouri-Kansas City (Dr Nelson) and the University of Kansas Medical Center, Kansas City (Dr Pierce).
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