Significance of the Positive Crossmatch Test in Kidney Transplantation

Patel, Ramon; Terasaki, Paul I.

doi:10.1056/nejm196904032801401

Cited by 1,356 publications

(765 citation statements)

References 6 publications

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“…Samples were screened for HLA antibodies using a standard complement-dependent cytotoxicity assay with an HLA-typed donor panel (to detect complement-fixing antibodies to HLA class I and II) 34 and a Luminex screening assay for HLA class I and II (Tepnel Lifecode Luminex Screen Deluxe). HLA class I and II antibodies were identified using a luminex single antigen bead technology (Tepnel Lifecode Luminex).…”

Section: Donor Antibody Analysismentioning

confidence: 99%

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The incidence, risk factors, and outcome of transfusion-related acute lung injury in a cohort of cardiac surgery patients: a prospective nested case-control study

Vlaar

Hofstra²,

Determann³

et al. 2011

Blood

188

176

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Section: Donor Antibody Analysismentioning

confidence: 99%

“…Smoking, n (%) 2 (13) 9 (28) 9 (28) Myocardial infarction, n (%) 2 (13) 11 (34) 10 ( Mean urea, mM, (SD) 7.4 (2.5) 6.8 (2.6) 6.4 (1.5)…”

Section: Medical Historymentioning

confidence: 99%

The incidence, risk factors, and outcome of transfusion-related acute lung injury in a cohort of cardiac surgery patients: a prospective nested case-control study

Vlaar

Hofstra²,

Determann³

et al. 2011

Blood

188

176

View full text Add to dashboard Cite

“…In the Eurotransplant region, the presence of donor‐specific HLA antibodies (DSAs) against a potential donor kidney causing complement‐mediated lysis8 is considered a contraindication for transplant. These antibodies can be detected with the complement‐dependent cytotoxicity crossmatch assay (CDC‐XM), which has been the gold standard since 1969.…”

Section: Introductionmentioning

confidence: 99%

Differential effects of donor-specific HLA antibodies in living versus deceased donor transplant

Kamburova

Wisse

Joosten

et al. 2018

American Journal of Transplantation

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The presence of donor‐specific anti‐HLA antibodies (DSAs) is associated with increased risk of graft failure after kidney transplant. We hypothesized that DSAs against HLA class I, class II, or both classes indicate a different risk for graft loss between deceased and living donor transplant. In this study, we investigated the impact of pretransplant DSAs, by using single antigen bead assays, on long‐term graft survival in 3237 deceased and 1487 living donor kidney transplants with a negative complement‐dependent crossmatch. In living donor transplants, we found a limited effect on graft survival of DSAs against class I or II antigens after transplant. Class I and II DSAs combined resulted in decreased 10‐year graft survival (84% to 75%). In contrast, after deceased donor transplant, patients with class I or class II DSAs had a 10‐year graft survival of 59% and 60%, respectively, both significantly lower than the survival for patients without DSAs (76%). The combination of class I and II DSAs resulted in a 10‐year survival of 54% in deceased donor transplants. In conclusion, class I and II DSAs are a clear risk factor for graft loss in deceased donor transplants, while in living donor transplants, class I and II DSAs seem to be associated with an increased risk for graft failure, but this could not be assessed due to their low prevalence.

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“…The presence of anti‐HLA antibodies that are specific for ≥1 HLA alleles of the organ donor before transplant has been associated with very poor outcomes and, in many cases, graft loss through hyperacute and antibody‐mediated rejection (ABMR) 1. In the past, the detection of donor‐specific antibodies (DSAs) pretransplant was considered a contraindication to transplant.…”

Section: Introductionmentioning

confidence: 99%

Safety, immunogenicity, pharmacokinetics, and efficacy of degradation of anti-HLA antibodies by IdeS (imlifidase) in chronic kidney disease patients

Lorant

Bengtsson

Eich

et al. 2018

American Journal of Transplantation

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Safety, immunogenicity, pharmacokinetics, and efficacy of the IgG‐degrading enzyme of Streptococcus pyogenes (IdeS [imlifidase]) were assessed in a single‐center, open‐label ascending‐dose study in highly sensitized patients with chronic kidney disease. Eight patients with cytotoxic PRAs (median cytotoxic PRAs of 64%) at enrollment received 1 or 2 intravenous infusions of IdeS on consecutive days (0.12 mg/kg body weight ×2 [n = 3]; 0.25 mg/kg ×1 [n = 3], or 0.25 mg/kg ×2 [n = 2]). IgG degradation was observed in all subjects after IdeS treatment, with <1% plasma IgG remaining within 48 hours and remaining low up to 7 days. Mean fluorescence intensity values of HLA class I and II reactivity were substantially reduced in all patients, and C1q binding to anti‐HLA was abolished. IdeS also cleaved the IgG‐type B cell receptor on CD19+ memory B cells. Anti‐IdeS antibodies developed 1 week after treatment, peaking at 2 weeks. A few hours after the second IdeS infusion, 1 patient received a deceased donor kidney offer. At enrollment, the patient had a positive serum crossmatch (HLA‐B7), detected by complement‐dependent cytotoxicity, flow cytometry, and multiplex bead assays. After IdeS infusion (0.12 mg/kg ×2) and when the HLA‐incompatible donor (HLA‐B7+) kidney was offered, the HLA antibody profile was negative. The kidney was transplanted successfully.

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Significance of the Positive Crossmatch Test in Kidney Transplantation

Cited by 1,356 publications

References 6 publications

The incidence, risk factors, and outcome of transfusion-related acute lung injury in a cohort of cardiac surgery patients: a prospective nested case-control study

The incidence, risk factors, and outcome of transfusion-related acute lung injury in a cohort of cardiac surgery patients: a prospective nested case-control study

Differential effects of donor-specific HLA antibodies in living versus deceased donor transplant

Safety, immunogenicity, pharmacokinetics, and efficacy of degradation of anti-HLA antibodies by IdeS (imlifidase) in chronic kidney disease patients

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