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Related Experiment Videos

Positive crossmatches against mandatorily shared kidneys.

B O Barger1, M Fotino, C M Zmijewski

  • 1UAB Regional Histocompatibility Laboratory, University of Alabama, Birmingham 35233.

Transplantation
|August 1, 1992
PubMed
Summary

Many kidney transplants are denied due to positive crossmatches (XM(+)), particularly in minority recipients. Researchers suggest re-evaluating crossmatch techniques and considering IgM autoantibodies to reduce unnecessary denials.

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Area of Science:

  • Nephrology
  • Transplantation Immunology
  • Organ Donation Policy

Background:

  • Mandatory sharing policies for donor kidneys can lead to transplant denials.
  • Positive final crossmatches (XM(+)) are a significant reason for these denials.
  • Certain demographic groups and highly sensitized patients are disproportionately affected.

Purpose of the Study:

  • To analyze the reasons for positive crossmatch denials in mandatory kidney sharing.
  • To identify potentially irrelevant causes of positive crossmatches.
  • To propose improvements in crossmatch evaluation and organ sharing criteria.

Main Methods:

  • Retrospective analysis of donor kidney shipments under the UNOS Mandatory Sharing Policy (October 1987-February 1990).
  • Categorization of positive crossmatch cases based on potential causes (autoantibodies, recent transfusions, XM technique, sensitization level, MHC antigens).

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  • Evaluation of the role of IgM autoantibodies and specific crossmatch techniques.

    • Main Results:

    • 8.5% of donor kidneys were denied due to XM(+) in the study period.
    • Hispanic and Black recipients showed higher rates of XM(+) denials.
    • A significant proportion (70%) of XM(+) cases may have been due to irrelevant factors like IgM autoantibodies or suboptimal XM techniques.
    • Highly sensitized patients with high panel reactive antibody (PRA) levels were overrepresented in the XM(+) group.

    Conclusions:

    • Many kidney transplant denials due to positive crossmatches may be avoidable.
    • Re-evaluation of crossmatch protocols, specifically for IgM autoantibodies, is recommended.
    • Sharing kidneys based on Human Leukocyte Antigen (HLA) DR subtypes could minimize exclusions due to positive B-cell crossmatches.