Measurement Of Predictive Value For The Flow Cytometry Crossmatch In Kidney Transplantation

objectives: The pre-transplant crossmatch is designed to detect preformed antibodies against donor human lymphocyte antigens (HLA) in the recipient's serum. Despite the modification of techniques to enhance the sensitivity of the complement-dependent cytotoxic cross-match (CDCXM), acute and accelerated acute rejection episodes are still frequent following kidney transplants, and may jeopardize graft survivals. Flow cytometry crossmatch (FCXM) was first used for pre-transplant crossmatch in 1983. While FCXM is generally accepted to be more sensitive than CDCXM for detecting low levels of donor-specific antibodies, the relevance of these is less clear since the assay offers no direct evidence of biological effect. A growing body of studies has examined the association between FCXM and acute rejection in the last decade; but there is no agreement regarding its objective value in predicting acute rejection to date. Some reports have claimed that FCXM positive recipients experienced a greater incidence of acute rejection, especially among the subgroups of recipients with high immunological risk, while other studies have showed negative results, indicating no advantage of FCXM over the CDCXM in terms of reducing acute rejection episodes. The aim of this study was to measure the predictive value of donor T cell-directed IgG FCXM for acute rejection and one-year graft loss following kidney transplantation under conditions of normal clinical practice. The study was conducted in two subgroups of living donor and cadaveric donor recipients who were at differing extremes of immunological risk based on the recipient panel reactive antibody level (PRA) and number of prior transplants.