The use of the kidney with an historical positive, and current negative crossmatch

Until recently, most transplant units required that a negative crossmatch using all available sera was an essential criterion which would ensure the best use of a donor kidney. This policy was accepted without clinical trial until 1982 when it was suggested that a donor kidney will function successfully in the majority of recipients with a negative crossmatch using current sera and a positive crossmatch with one or more non-current sera, i.e., sera taken 3 or more months prior to the time of the transplant. In the 14 reported series addressing this question, the average 1-year graft survival ranges between 53% and 100% in these highly sensitized patients who receive a primary graft, and between 0% and 100% in those who receive a secondary graft. Controversy does exist as to whether a positive crossmatch in non-current sera is an additional risk factor, i.e., that it decreases graft survival significantly when compared with a similar group of highly sensitized patients who were transplanted with a negative crossmatch on all available pre-transplant sera. Of the published studies on this subject, the majority, but not all, find that there is no difference between controls and positive crossmatch patients who receive a primary graft, but those that receive a secondary graft may be at increased risk. The reasons for the different results from these studies may be related to differences in the many variables which influence graft outcome between various study groups.