Journal
TRANSPLANT INTERNATIONAL
Volume 24, Issue 6, Pages 560-569Publisher
WILEY
DOI: 10.1111/j.1432-2277.2011.01235.x
Keywords
antibody-mediated rejection; HLA-antibodies; risk stratification; virtual crossmatch
Categories
Funding
- Swiss Kidney Foundation
- Swiss National Science Foundation [32473B_125482/1]
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P>The virtual crossmatch (virtual-XM) has been proposed for accurate identification of donor-specific HLA-antibodies, but large prospective studies assessing its value for pretransplant risk stratification are lacking. A total of 233 consecutive renal allograft recipients were prospectively stratified according to the virtual-XM. In patients with a negative virtual-XM (n = 190, 82%), prospective cytotoxicity crossmatches (CDC-XM) were omitted, and they received standard immunosuppression. Virtual-XM positive patients were only transplanted if CDC-XM were negative. They received additional induction with anti-T-lymphocyte-globulin and intravenous immunoglobulins (n = 43, 18%). The cumulative incidence of clinical/subclinical antibody-mediated rejection (AMR) at 1 year was lower in the negative virtual-XM than in the positive virtual-XM group [15/190 (8%) vs. 18/43 (42%); P < 0.0001]. After a median follow-up of 2.6 years, allograft loss because of AMR occurred less often in the negative virtual-XM group (1% vs. 7%; P = 0.04) and death-censored allograft survival at 2 years was higher (98% vs. 91%; P = 0.02). Serum creatinine was not different at the last follow-up (129 mu m vs. 130 mu m; P = 0.58). We conclude that a negative virtual-XM defines patients at low risk for AMR and early allograft loss, while a positive virtual-XM represents a significant risk for AMR despite enhanced induction therapy. This supports the utility of the virtual-XM for risk stratification and treatment allocation.
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