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Sensitization and crossmatch
1UCLA Tissue Typing Laboratory, Los Angeles, California, USA.
A transfusion effect was observable in the half-lives of recent transplants. The half-life of non-transfused, nulliparous patients transplanted between 1992-1994 was 7.9 years compared to 9.1 years for transfused and 9.6 for retransplanted recipients. Patients whose PRA was measured by AHG were more likely to be broadly sensitized, had a significantly less frequent need for dialysis in the first week posttransplant, and had improved graft outcome regardless of their sensitization level. The decrease in the PNF rate from 10% in 1985 to 3% in 1994 can be attributed to improved crossmatch techniques. Patients with NIH- Flow+ or Wash- AHG+ crossmatches had significantly higher PNF rates. Broadly sensitized recipients (>50% PRA) treated with OKT3 or ALG induction therapy had half the incidence of hospital rejection and a 4-year survival rate of 62% compared to 55% for untreated recipients. Sensitized recipients of zero HLA-A,B,DR- and zero residue-mismatched kidneys had 4-year survival rates of 72% and 65%, respectively, compared with 53% for recipients of residue-mismatched grafts. National sharing has provided HLA-matched kidneys for broadly sensitized recipients. Nineteen percent of broadly sensitized recipients received a zero conventional or HLA residue-mismatched kidney. Regraft recipients matched for HLA residues had the same 4-year graft outcome (68%) as zero HLA-A,B,DR-mismatched recipients, regardless of sensitization level. Both conventional HLA matching and HLA-residue matching reduced the chance that a failed graft would result in broad sensitization. HLA matching was suggested to prevent broad sensitization of pediatric recipients. Half-life for broadly sensitized patients under 18 years of age was 4.9 years and their 4-year graft survival was only 45%.
A transfusion effect was observable in the half-lives of recent transplants. The half-life of non-transfused, nulliparous patients transplanted between 1992-1994 was 7.9 years compared to 9.1 years for transfused and 9.6 for retransplanted recipients. Patients whose PRA was measured by AHG were more likely to be broadly sensitized, had a significantly less frequent need for dialysis in the first week posttransplant, and had improved graft outcome regardless of their sensitization level. The decrease in the PNF rate from 10% in 1985 to 3% in 1994 can be attributed to improved crossmatch techniques. Patients with NIH- Flow+ or Wash- AHG+ crossmatches had significantly higher PNF rates. Broadly sensitized recipients (>50% PRA) treated with OKT3 or ALG induction therapy had half the incidence of hospital rejection and a 4-year survival rate of 62% compared to 55% for untreated recipients. Sensitized recipients of zero HLA-A,B,DR- and zero residue-mismatched kidneys had 4-year survival rates of 72% and 65%, respectively, compared with 53% for recipients of residue-mismatched grafts. National sharing has provided HLA-matched kidneys for broadly sensitized recipients. Nineteen percent of broadly sensitized recipients received a zero conventional or HLA residue-mismatched kidney. Regraft recipients matched for HLA residues had the same 4-year graft outcome (68%) as zero HLA-A,B,DR-mismatched recipients, regardless of sensitization level. Both conventional HLA matching and HLA-residue matching reduced the chance that a failed graft would result in broad sensitization. HLA matching was suggested to prevent broad sensitization of pediatric recipients. Half-life for broadly sensitized patients under 18 years of age was 4.9 years and their 4-year graft survival was only 45%.