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Comparison of complement-dependent cytotoxic and flow-cytometry crossmatch results before cadaveric kidney
T K Ayna1, M Soyöz, Y Kurtulmuş
1Department of Medical Biology and Genetics, Izmir Katip Çelebi University, Izmir, Turkey. tulayayna@gmail.com
Insights
Comparing kidney transplant crossmatch methods, this study found significant discordance between complement-dependent cytotoxic crossmatch (CDCXM) and flow cytometry crossmatch (FCXM). Both methods are suggested for detecting donor-specific antibodies (DSA) to improve graft survival.
Area of Science:
- Immunology
- Transplantation Science
- Clinical Chemistry
Background:
- Donor-specific antibodies (DSA) significantly reduce kidney graft survival.
- Accurate crossmatch testing is crucial for pre-kidney transplantation assessment.
- Previous immunization history is a key factor in positive crossmatch results.
Purpose of the Study:
- To compare the results of complement-dependent cytotoxic crossmatch (CDCXM) and flow cytometry crossmatch (FCXM) in kidney transplantation candidates.
- To evaluate the concordance and discordance rates between CDCXM and FCXM.
- To assess the clinical implications of differing crossmatch results for cadaveric renal donation.
Main Methods:
- Tested 47 kidney transplantation candidates, including 10 for cadaveric donor organs.
- Performed both CDCXM and FCXM using spleen cells as the lymphocyte source.
- Analyzed T and B cell ratios and calculated concordance/discordance ratios between the two methods.
Main Results:
- A concordance rate of 76.6% was observed between CDCXM and FCXM, with 23.4% discordant results.
- Discordant results included 4.2% positive CDCXM/negative FCXM and 191% negative CDCXM/positive FCXM.
- All positive crossmatches were associated with prior patient immunization history.
Conclusions:
- The study suggests potential issues with FCXM washing procedures affecting antigen-antibody complexes, leading to false negatives.
- CDCXM detects critical IgG1 and IgG3, while FCXM detects all IgG subgroups due to higher sensitivity.
- Performing both CDCXM and FCXM is recommended as a preferable strategy for detecting DSAs to improve kidney transplant outcomes.
Aim:
The presence of HLA donor-specific antibodies (DSA) before kidney transplantation decreases graft survival. In this study, we compared crossmatch results of kidney transplantation candidates, for cadaveric renal donation between March 10, 2012, and September 7, 2012.
Material And Method:
The 47 kidney transplantation candidates tested for crossmatch included 10 for cadaveric donor organs. Two crossmatch methods were performed: complement-dependent cytotoxic crossmatch (CDCXM) and flow cytometry crossmatch (FCXM). Spleen cells were used as the source of lymphocytes for all crossmatch tests.
Results:
The T and B cell ratios isolated from spleen were 38.8% and 34.8%, respectively. The concordance ratio of the two methods was 76.6% with 23.4% discordant results. Regarding the discordant results, 4.2% were positive CDCXM but negative FCXM; 191%, negative CDCXM but positive FCXM. All patients displaying positive crossmatches had a previous immunization history. As a result, we speculated that the positive CDCXM but negative FCXM results were due to the washing procedures in the FCXM disturbing antigen-antibody complexes. We suggest at least two different methods to be performed for crossmatch tests before kidney transplantation. CDCXM detects immunoglobulin G1 (IgG1) and IgG3, which are critical for rejection. FCXM is able to detect all IgG subgroups because of its high sensivity. As a result we suggest that both CDCXM and FCXM are preferrable strategies to detect DSAs.
