Phasing out the pre-transplant cytotoxicity crossmatch: Are we missing something?

Area of Science:

• Nephrology
• Immunology
• Transplantation Science

Background:

• The anti-human globulin-enhanced complement-dependent cytotoxicity crossmatch (AHG-CDCXM) is a standard assay for detecting donor-specific antibodies (DSA) before kidney transplantation.
• The flow cytometric crossmatch (FCXM) assay was developed as a supplementary test to AHG-CDCXM.

Purpose of the Study:

• To clinically validate the sole use of the FCXM assay in kidney transplantation.
• To assess if replacing AHG-CDCXM with FCXM impacts clinical outcomes.

Main Methods:

• A comparative study design was employed.
• Kidney transplant patients were divided into two groups: one undergoing FCXM only, and a control group undergoing AHG-CDCXM.

Main Results:

• No significant differences in patient survival (p=0.591) or graft survival (p=0.692) were observed between the FCXM and control groups at one year post-transplant.
• The incidence of acute cellular rejection (Banff ≥ 1A) was similar between groups (p=0.289).
• However, acute antibody-mediated rejections were significantly higher in the control group (p=0.028).

Conclusions:

• Discontinuing the AHG-CDCXM assay in favor of FCXM alone does not adversely affect clinical outcomes within a one-year follow-up period.
• FCXM may be a sufficient method for pre-transplant crossmatching, potentially reducing unnecessary testing.