CAN AN IMMUNE, NON-REACTIVE (ANTI-HLA) RECIPIENT BE TRANSPLANTED WITHOUT A DONOR-SPECIFIC CROSSMATCH?

Le résumé fourni par la source

452 ASHI standards require that donor-specific crossmatches be performed before a renal transplant operation. Crossmatching tests the recipient pretransplant and highest, historical PRA sera for anti-donor antibodies, and may take from 4 to 8 hours (or more) to perform depending upon whether the recipient is in the local area or from out of town. This delay can often lead to problems associated with the availability of the operating room and may result in increased cold ischemia time which can increase the risk of delayed graft function. Every transplant center has patients who have either never been allosensitized by transfusion, pregnancy, previous transplant or infection or who have never displayed detectable anti-HLA reactivity in panel screening. Can these potential recipients be transplanted without a final crossmatch in order to avoid the delayed operation for some patients? To address this question we evaluated the PRA values and all donor IgG-AHG crossmatch results of 1,165 sera (minimum of 5/patient) from 126 potential primary recipients of a cadaveric allograft. Twenty percent of these patients(25/126) consistently presented with a 0% PRA. Moreover, when their sera(N=156) were crossmatched against potential donors an IgG positive AHG crossmatch occurred only once, thereby resulting in a risk frequency of 0.6%(1/156) for the occurrence of a deleterious crossmatch. Eleven percent of these patients (14/126) consistently presented with a 1% PRA and crossmatch testing of their sera resulted in a deleterious IgG-AHG positive crossmatch occurring only once in 66 crossmatches resulting in a risk frequency of 1.5%(1/66). As the % PRA increased from 2% to greater than 5%, the risk frequency increased from 6% to 45% for the occurrence of a deleterious IgG positive-AHG crossmatch. These data suggest that if patient sera are carefully screened to delineate the absence of IgG anti-HLA antibodies, and a history exists for negative crossmatch results against potential donors, it is possible that a final donor-specific crossmatch may not be necessary in a highly selected group of potential recipients.

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