A Virtual Crossmatch-based Strategy Facilitates Sharing of Deceased Donor Kidneys for Highly Sensitized Recipients
| Autor: | Luis Mayen, Peter G. Stock, Chris E. Freise, Zoltan Laszik, Nancy L. Ascher, Allison B. Webber, Kelly Cunniffe, Shareef Syed, Sandy Feng, David H Gae, John P. Roberts, Mehdi Tavakol, Garrett R. Roll, Ryutaro Hirose, Raja Rajalingam |
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| Rok vydání: | 2020 |
| Předmět: |
Graft Rejection
Male medicine.medical_specialty Blood transfusion medicine.medical_treatment Kidney Donor Selection Highly sensitized HLA Antigens Isoantibodies Internal medicine Humans Medicine Retrospective Studies Transplantation Deceased donor Retrospective review business.industry Histocompatibility Testing Panel reactive antibody Retrospective cohort study Allografts Flow Cytometry Kidney Transplantation Tissue Donors Transplant Recipients Female business Immunologic Memory Immunologic memory |
| Zdroj: | Transplantation. 104:1239-1245 |
| ISSN: | 0041-1337 |
| DOI: | 10.1097/tp.0000000000002924 |
| Popis: | Background It is estimated that 19.2% of kidneys exported for candidates with >98% calculated panel reactive antibodies are transplanted into unintended recipients, most commonly due to positive physical crossmatch (PXM). We describe the application of a virtual crossmatch (VXM) that has resulted in a very low rate of transplantation into unintended recipients. Methods We performed a retrospective review of kidneys imported to our center to assess the reasons driving late reallocation based on the type of pretransplant crossmatch used for the intended recipient. Results From December 2014 to October 2017, 254 kidneys were imported based on our assessment of a VXM. Of these, 215 (84.6%) were transplanted without a pretransplant PXM. The remaining 39 (15.4%) recipients required a PXM on admission using a new sample because they did not have an HLA antibody test within the preceding 3 months or because they had a recent blood transfusion. A total of 93% of the imported kidneys were transplanted into intended recipients. There were 18 late reallocations: 9 (3.5%) due to identification of a new recipient medical problem upon admission, 5 (2%) due to suboptimal organ quality on arrival, and only 4 (1.6%) due to a positive PXM or HLA antibody concern. A total of 42% of the recipients of imported kidneys had a 100% calculated panel reactive antibodies. There were no hyperacute rejections and very infrequent acute rejection in the first year suggesting no evidence for immunologic memory response. Conclusions Seamless sharing is within reach, even when kidneys are shipped long distances for highly sensitized recipients. Late reallocations can be almost entirely avoided with a strategy that relies heavily on VXM. |
| Databáze: | OpenAIRE |
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