Cross-matches in Transplantation: Each is Complementary to Other

Abstract

Immune system, which is an obligatory component of body’s defense mechanism, is the main barrier for allogenic transplantation. Perfect selection of donor on the basis of human leucocyte antigen (HLA) compatibility and cross-matching are the key components of successful transplantation. Cross-match eliminates the chance of hyper-acute rejection and also ensures the long term graft survival. In 1960s, T-cell complement-dependent cytotoxicity cross-match was firstintroduced; since then it is mandatory component of transplantation workup process. With the advances of time different newer cross-match technics are evolved for determining the likelihood of donor-specific antibody-mediated responses, including flow cytometric cross-match and virtual cross-match using luminous microbead assay. Flow cytometric cross-match and luminous microbead assay are more sensitive and specific than the previous one, however all are complimentary to each other for final selection of donor recipient couple. This article builds an understanding of modern day cross-match interpretation using a complicated case-based approach.Birdem Med J 2016; 6(2): 118-126

Evaluation of three different laboratory methods to detect preformed human leukocyte antigen antibodies in a South African kidney transplant population

“…Renal transplantation is the option of choice in RRT for patients with end-stage kidney disease 20 , 21 . In South Africa, the CDC pre-transplant crossmatching method is still widely used as a technique of choice in the pre-renal transplantation work-up 14 , 15 , and is routinely used in our setting for both deceased and live donor pre-transplantation.…”

“…False-negative results may occur if there are low levels of DSA or if the antibody isotype does not activate complement. In this context, HLA antibodies of the IgG2 and IgG4 subclasses are unable to activate complement cascade and consequently will not be detected 21 , 27 , 28 . In addition, CDCXM is also known to be reactive with non-specific antibodies (i.e.…”

“…In addition, CDCXM is also known to be reactive with non-specific antibodies (i.e. IgM antibodies) leading to false-positive reactions, hence more specific and sensitive techniques are required 2 , 21 , 29 . Our results showed a 40% false-positivity rate for HLA Class II, which confirms the lack of sensitivity of this procedure.…”

Impact of pregnancy on allosensitization in women with stage 5 chronic kidney disease

“…Тем не менее, на основании имеющихся исследований разумно заключить, что иммунологическая основа для исключения женщин без обнаруживаемых анти-HLA антител, который имеет HLA-специфичность с предыдущей беременностью, невелика. Более того, существует достаточно доказательств, чтобы рассматривать рожавших женщин с 0% PRA как группу низкого иммунологического риска [25,30].…”