P009 Profiling for patients with positive autologous or false positive allogenic flow cytometry cross match

Autor: Steve Leckie, Qingyong Xu, Patrick Luke, Lakshman Gunaratnam, Anthony M. Jevnikar
Rok vydání: 2017
Předmět:
Zdroj: Human Immunology. 78:60
ISSN: 0198-8859
Popis: Aim To determine the native disease profile for patients who have positive autologous or false positive allogeneic flow cytometry crosshatches (FCXM). Methods We reviewed Allo and auto FCXM performed in the past 3 years. FCXMs were performed with conventional methods using Ficoll-purified cells (old method). After May 2015, FCXMs were performed with the modified Halifax protocol using RoboSep-purified cells (new method). Results 530 patients waiting for heart, kidney or any kidney-combined organ transplant were studied. 44 (8.3%) had either positive (n = 35) or borderline positive (n = 9) auto FCXMs. There are significantly more positive auto FCXMs with the old method 25/161 (14.6%) vs. the new method (19/359, 5.35%). Patients whose end stage renal diseases were due to autoimmunity (vasculitis, lupus), IgA nephropathy, or toxicity (calcineurin inhibitor, lithium) had more positive auto FCXMs (RR = 3, P = 0.0003) vs. patients with other diseases. The risk is higher (RR = 4.52) with patients tested using the new method. These 3 diseases are named as disease susceptible for false positive XMs (DisFPX). Analysis of patients waiting for kidney-related transplants with native diseases other than DisFPX and tested with the new FCXM method (n = 280) showed that peritoneal dialysis (PD) gives a higher risk for positive auto XM vs. either hemodialysis or pre-emptive (RR = 3.24, p = 0.04). High PRA (>80%) is a risk for positive auto FCXMs when tested with the old method (RR = 2.54, P = 0.01) but not with the new method (RR = 1.21, P = 0.8). Combining DisFPX and PD can explain 56.1% (23/41) of positive auto XM in all renal patients and 70.1% (12/17) of those tested with the new method. Allogeneic FCXM (n = 750) with deceased donors performed in the same period were reviewed. 30 patients were found to have false positive allogeneic FCXMs (N = 12 with old method, n = 18 for new method). Most patients with false positive allo FCXM have either DisFPX/PD (19/30, 66.3%), or DisFPX/PD/PRA > 80% (25/30, 83%). Conclusions This is the 1st report that other than well-known autoimmune diseases, patients with IgA nephropathy, nephrotoxicity or those on peritoneal dialysis are also prone to positive auto FCXMs or false positive allo FCXMs. This is helpful when interpreting an unexpected positive FCXM after a negative virtual XM.
Databáze: OpenAIRE
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