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Related Concept Videos

Kidney Transplant I: Introduction01:28

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A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
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Related Experiment Video

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Murine Kidney Transplant Technique
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Virtual crossmatch in kidney transplantation.

A Piazza1, G Ozzella1, E Poggi1

  • 1Regional Transplant Center, Lazio Region-National Council of Research, IFT UOS di Roma S Camillo, Rome, Italy.

Transplantation Proceedings
|September 23, 2014
PubMed
Summary

The virtual crossmatch (v-XM) protocol accurately predicts kidney transplant compatibility, with high sensitivity for detecting donor-specific antibodies (DSA). Evaluating DSA strength is crucial for recipient selection and accurate v-XM implementation.

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Area of Science:

  • Nephrology
  • Immunology
  • Transplant Surgery

Background:

  • Luminex Single-Antigen Beads (LSA) assay detects donor-specific antibodies (DSA) in kidney transplant candidates.
  • LSA's sensitivity in detecting low antibody levels complicates accurate crossmatch prediction for donor selection.

Purpose of the Study:

  • To retrospectively analyze the accuracy of a virtual crossmatch (v-XM) protocol in predicting actual crossmatch (a-XM) results.
  • To investigate the correlation between negative a-XM results and the strength/specificity of preformed DSA.

Main Methods:

  • Analyzed correlation between negative v-XMs and a-XMs from 2007-2012.
  • Defined 'unacceptable DSA' (MFI≥5,000) and 'acceptable DSA' (MFI<5,000) based on LSA.
  • Performed 507 a-XMs using complement-dependent cytotoxicity (CDC) and flow cytometry (FC) on 256 candidates and 302 donors.

Main Results:

  • v-XM negative results correlated well with CDC (97%) and FC (90%) a-XMs.
  • v-XM demonstrated 100% sensitivity due to no false-negative DSA results.
  • Specificity was limited (74% CDC, 79% FC) by 'acceptable' or anti-DQA/DPB DSA.

Conclusions:

  • The v-XM protocol exhibits high sensitivity for predicting immunologic compatibility in kidney transplantation.
  • Evaluating DSA strength is vital for effective v-XM implementation in recipient selection.
  • Accurate v-XM requires defining all donor HLA molecules, especially for anti-DQA/DPB DSA detection.