[Immunologic study of the donor-receptor couple]

Area of Science:

• Transplantation immunology
• Immunogenetics
• Clinical diagnostics

Context:

• Donor-specific antibodies and HLA incompatibilities are key factors in graft failure.
• Pre-transplant assessment involves HLA typing, alloantibody screening (PRA-CDC, Solid Phase), and virtual crossmatch.
• Post-transplant monitoring is essential for diagnosing rejection and predicting long-term graft survival.

Purpose:

• To evaluate the risk of graft failure by identifying donor-specific antibodies and HLA incompatibilities.
• To compare the sensitivity and prognostic value of different alloantibody detection methods.
• To assess the utility of various crossmatch techniques (Cytotoxicity, Flow-Cytometry, Virtual) in predicting transplant outcomes.

Summary:

• Pre-transplant evaluation includes HLA typing, alloantibody screening (PRA-CDC, Solid Phase), and virtual crossmatch for sensitized recipients.
• Crossmatch methods like Cytotoxicity (CM-CDC) and Flow-Cytometry (FCCM) are used pre-transplant, with FCCM particularly useful for re-transplants.
• Post-transplant, alloantibody identification aids in diagnosing humoral rejection and serves as a marker for long-term graft survival.

Impact:

• Cytotoxicity crossmatch identifies high risk for hyperacute rejection, serving as a contraindication.
• Flow Cytometry crossmatch predicts increased graft loss risk in the first year, especially for re-transplants (>30%).
• Virtual crossmatch indicates a higher probability of antibody-mediated rejection (5-55%) but may not always contraindicate transplantation.