Flow cytometric crossmatching in human organ transplantation

When donor class I directed 'warm' antibodies are detected by the conventional cytotoxic crossmatch preoperatively, there is a negative correlation with outcome in renal, liver, cardiac and pancreatic transplantation. When the cytotoxic crossmatch assay is negative and IgG antibodies to T donor lymphocytes are shown to be present in the recipient sera by flow cytometry then there is an increase in postoperative complications in renal transplants. This includes primary nonfunction and treatable rejection which in some cases results in graft failure. Since its introduction into clinical practice for recipient selection in Newcastle, the complication rate of rejection episodes, primary nonfunction and graft failure has been reduced. When applied to other organs there seems to be a definite detrimental association between a positive flow cytometric crossmatch preoperatively and rejection in cardiac transplantation, in some cases leading to death. The role in liver and pancreas transplants to date has not been determined. In the postoperative period there appears to be a limited role for the flow cytometric crossmatch in the detection of antibody prior to the first clinical episode of rejection. This has been applied to renal transplants but to no other organ.