Abstract
Aim Implementation of the virtual crossmatch should aid redistribution of organs to sensitized individuals. However the number of organ offers falls rapidly with increasing cPRA. Thus, additional strategies to improve transplantation rate of highly sensitized individuals are warranted. A 49 year old Hispanic woman with ESRD from DMII/hypertension and no sensitizing events showed: HLA genotype A33 68, B7 51, Cw15 15, DR8 14 52, DQ4 7; cPRA of 100% by single antigen (SA) bead testing; and autoantibody to Cw15 and DR8,14,52. The patient was listed in UNOS with cPRA 100% on 7-21-10. Methods Additional flow crossmatching and HLA antibody testing to refine virtual crossmatch information in UNOS was performed to facilitate organ offers. Results SA results were reproducible over time and confirmed by the vendor laboratory, while testing using different reagents showed no antibody to HLA class II. The flow auto crossmatch and allo crossmatches against six surrogate donors with predictive DSA based on the SA findings (DR1,4,7,9,11,13,14,15,51,52,53) were negative. Using a MFI cutoff of 10,000 based on these results the patient’s cPRA was readjusted in UNOS to 4%. She was transplanted 7-30-13 with deceased-donor kidney (HLA A3 B35,61 C4,10 DR8,17, R52 DQ2,4). Delayed graft function requiring intermittent dialysis x5 occurred post-op. No increase in DSA by SA was noted post-transplant. She required readmission once with septic shock thought secondary to ischemic colitis. Creatinine eventually reached a nadir of 0.8 mg/dl. Conclusions This case illustrates variability in the performance of standard assays to evaluate the presence and clinical significance of DSA and the need to supplement these assays.
Published Version
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