Abstract
Introduction: The anti-human globulin-enhanced complement-dependent cytotoxicity crossmatch (AHG-CDCXM) assay has been used to assess the presence of donor-specific antibodies (DSA) in recipient’s serum before kidney transplantation. The flow cytometric crossmatch (FCXM) assay was first introduced as an additional test. The aim of this study was to clinically validate the single use of the FCXM assay.Methods: This study compared the outcomes of a cohort of kidney transplant patients that underwent FCXM only (FCXM group) versus a cohort of kidney transplant patients that underwent AHG-CDCXM (control group).Results: Ninety-seven patients in the FCXM group and 98 controls were included. All crossmatches in the control group were negative. One patient in the FCXM group had a positive B cell crossmatch. One year after transplantation, there were no significant differences in patient survival (p = 0.591) and graft survival (p = 0.692) between the groups. Also, no significant difference was found in the incidence of Banff ≥ 1A acute cellular rejection episodes (p = 0.289). However, acute antibody-mediated rejections occurred in 3 controls (p = 0.028).Conclusion: The results showed that discontinuing the AHG-CDCXM assay does not modify the clinical outcomes in a 1-year follow-up.
Highlights
The anti-human globulin-enhanced complement-dependent cytotoxicity crossmatch (AHG-CDCXM) assay has been used to assess the presence of donor-specific antibodies (DSA) in recipient’s serum before kidney transplantation
Modifications have been made to enhance its sensitivity, such as the addition of anti-human globulin (AHG), as some patients had no detectable antibodies on the CDCXM but suffered from acute antibody-mediated graft rejection and loss.[6]
A substantial increase in crossmatch sensitivity was observed with the use of the flow cytometric crossmatch (FCXM).7–9antiHLA did the FCXM assay provide enhanced sensitivity and required less time to be performed, leading to a reduction in cold ischemia time (CIT), which is inherent to deceased donor transplantation and one of the main predictors of initial graft function.[10]
Summary
The anti-human globulin-enhanced complement-dependent cytotoxicity crossmatch (AHG-CDCXM) assay has been used to assess the presence of donor-specific antibodies (DSA) in recipient’s serum before kidney transplantation. The complement-dependent cytotoxicity crossmatch (CDCXM) assay was proposed by Terasaki in 1969and has been commonly used to assess donor-recipient antibodies.[5] Since modifications have been made to enhance its sensitivity, such as the addition of anti-human globulin (AHG), as some patients had no detectable antibodies on the CDCXM but suffered from acute antibody-mediated graft rejection and loss.[6] A substantial increase in crossmatch sensitivity was observed with the use of the flow cytometric crossmatch (FCXM).7–9antiHLA did the FCXM assay provide enhanced sensitivity and required less time to be performed, leading to a reduction in cold ischemia time (CIT), which is inherent to deceased donor transplantation and one of the main predictors of initial graft function.[10] In 2011, a new FCXM protocol was proposed by Liwski et al.[11] The so-called Halifax protocol reduced even further the total assay time, thereby contributing to a significant decrease in CIT
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