Abstract
In order to select recipients without donor-specific anti-HLA antibodies, the complement-dependent cytotoxicity crossmatch (CDC-CM) was established as the standard procedure about 40 years ago. However, the interpretability of this functional assay strongly depends on the vitality of isolated donors' lymphocytes. Since the application of therapeutic antibodies for the immunosuppressive regimen falsifies the outcome of the CDC-crossmatch as a result of these antibodies' complement-activating capacity in the recipients' sera, we looked for an alternative methodical approach. We here present 27 examples of AB0 blood group-incompatible living kidney allograft recipients who, due to their treatment with the humanized chimeric monoclonal anti-CD20 antibody Rituximab, did not present valid outcomes of CDC-based pretransplant cross-matching. Additionally, four cases of posttransplant cross-matching after living kidney allografting and consequent treatment with the therapeutic anti-CD25 antibody Basiliximab (Simulect) due to acute biopsy-proven rejection episodes are presented and compared regarding CDC- and ELISA-based crossmatch outcomes. In all cases, it became evident that the classical CDC-based crossmatch was completely unfeasible for the detection of donor-specific anti-HLA antibodies, whereas ELISA-based cross-matching not requiring vital cells was not artificially affected. We conclude that ELISA-based cross-matching is a valuable tool to methodically circumvent false positive CDC-based crossmatch results in the presence of therapeutically applied antibodies.
Highlights
It has been known for more than forty years that antibodies which are directed against HLA antigens of a given donor represent the dominating reason for hyperacute or acute rejections of renal allografts and allografts of other organs
False Positive complement-dependent cytotoxicity (CDC)-Based Crossmatch Results in Patients Pretreated with the Therapeutical Antibodies Rituximab and/ or Basiliximab
During the last decade, humanized monoclonal antibodies have increasingly been used for preconditioning AB0 blood group-incompatible recipients of living kidney donations or for the therapy of acute rejection episodes
Summary
It has been known for more than forty years that antibodies which are directed against HLA antigens of a given donor represent the dominating reason for hyperacute or acute rejections of renal allografts and allografts of other organs. Alternative solid phase-based cross-matching is shown as an adequate way to lead to valid detections of donor-specific antibodies in spite of Rituximab treatment generally used prior to AB0 blood group-incompatible living kidney donations and Basiliximab treatment in many transplant centers used to counter rejection episodes after kidney grafting.
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