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June 1996

Improved Graft Survival in Cadaveric Renal Retransplantation by Flow Crossmatching

Author Affiliations

From the Midwest Organ Bank Inc, Westwood, Kan (Drs Nelson and Bryan and Ms Eschliman); St Francis Medical Center, Wichita, Kan (Dr Shield); Research Medical Center, Kansas City, Mo (Dr Aeder); the Department of Pathology, University of Missouri-Columbia (Dr Luger); the Departments of Surgery, the University of Missouri-Kansas City (Dr Nelson) and the University of Kansas Medical Center, Kansas City (Dr Pierce).

Arch Surg. 1996;131(6):599-603. doi:10.1001/archsurg.1996.01430180025004

Objective:  To evaluate the role of flow cytometry crossmatching on graft survival in patients undergoing cadaveric renal retransplantation compared with our conventional antihuman globulin cytotoxic crossmatch.

Design:  In 1990, 6 of 7 transplantation centers in 1 organ procurement organization service area began performing cadaveric renal retransplantation only if the flow T-cell IgG crossmatch was negative. During that period, 1 center continued to use only the antihuman globulin T-cell IgG crossmatch. Prior to 1990, all centers used only the antihuman globulin T-cell IgG crossmatch as their crossmatch selection criterion for retransplantation. Regraft survival was compared between those centers by crossmatch selection criteria.

Patients:  Patient selection and immunosuppression decisions were made at the transplantation center.

Setting:  All flow cytometry crossmatches for all 7 centers participating in the evaluation were performed at the Histocompatibility Laboratory of the Midwest Organ Bank Inc, Westwood, Kan.

Results:  Graft survival is significantly better (P=.03 [logrank test]) in regrafts when the flow crossmatch is used to select patients for transplantation.

Conclusion:  Flow crossmatching improves graft survival in cadaveric renal retransplantation by identifying a subset of patients with donor-directed HLA class I antibodies that are not detectable by our conventional antihuman globulin crossmatch.(Arch Surg. 1996;131:599-603)