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Positive crossmatches--when is it safe to transplant?
1Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, UK.
Summary
The interpretation of positive lymphocytotoxic crossmatch tests in renal transplantation has evolved. While previously contraindicated, successful positive crossmatch transplants are now performed, but specific conditions require further understanding.
Area of Science:
- Nephrology
- Immunology
- Transplantation
Background:
- The traditional view prohibited renal transplants with positive lymphocytotoxic crossmatch tests.
- This dogma, established in the mid-1960s, is no longer considered absolute.
- Numerous successful positive crossmatch kidney transplants have been performed.
Purpose of the Study:
- To re-evaluate the interpretation of positive lymphocytotoxic crossmatch tests.
- To identify factors influencing the decision to proceed with transplantation despite a positive crossmatch.
- To understand the evolving criteria for positive crossmatch renal transplants.
Main Methods:
- Review of historical and current practices regarding lymphocytotoxic crossmatch testing.
- Analysis of factors influencing transplant outcomes in positive crossmatch scenarios.
- Consideration of antibody specificity, time intervals, and immunoglobulin class.
Main Results:
- The strict contraindication for positive crossmatch renal transplants is no longer universally applied.
- Successful transplantation in the presence of a positive crossmatch is achievable.
- Key factors influencing outcomes include antibody specificity (HLA class I, II, non-HLA), time to transplant, and antibody immunoglobulin class (IgG, IgM).
Conclusions:
- The interpretation of positive lymphocytotoxic crossmatch tests has significantly changed.
- Transplantation decisions require careful consideration of specific immunological factors.
- Further research is needed to fully elucidate the conditions for successful positive crossmatch renal transplantation.