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Presensitization and the renal allograft recipient
L A Turka1, J E Goguen, J E Gagne
1Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Transplantation
|February 1, 1989
Summary
Computer predictions can identify highly sensitized patients, potentially streamlining organ transplantation. However, positive historical crossmatches significantly reduce graft survival, impacting national organ sharing efforts.
Area of Science:
- Transplantation immunology
- Organ transplantation outcomes
Background:
- Patient sensitization is a critical factor in allograft survival.
- Current crossmatching strategies aim to optimize recipient eligibility and organ allocation.
Purpose of the Study:
- To evaluate the accuracy of computer-predicted crossmatches against actual crossmatches.
- To assess the impact of historical positive crossmatches on long-term allograft survival.
Main Methods:
- Comparison of computer-predicted crossmatch results with 3622 actual crossmatches.
- Analysis of one-year actuarial graft survival based on historical crossmatch status (positive vs. negative/none).
Main Results:
- Computer-predicted positive crossmatches were highly accurate (91-99% PPV) for patients with >=40% reactive antibodies, potentially eliminating the need for actual crossmatches.
- Negative computer predictions were insufficient to replace actual crossmatching.
- One-year graft survival was significantly lower in patients with positive historical crossmatches (61.0%) compared to those without (85.2%, P < 0.001).
- This adverse effect was observed in both first-time and regrafted patients.
Conclusions:
- Computer predictions can effectively identify highly sensitized patients, aiding in recipient selection.
- Positive historical crossmatches negatively impact allograft survival, posing a challenge for national organ sharing.
- Refining crossmatching protocols is essential to improve organ transplantation outcomes.