[Which cross-match before organ transplantation in 1997?]

The objective of pre-transplantation cross-matching is to detect in the recipient's serum solely those anti-donor antibodies which could have a deleterious effect on the grafted organ. It is important to avoid refusing organs on the basis of recipient antibodies which do not imply a risk of rejection.

In most laboratories cross-matching or compatibility tests made before organ transplantation are based on a complement-dependent microlymphocytotoxicity technique, sometimes sensitized with anti-human globulin serum, reactive against target T-cells. A positive results is reported if the reactions are week, but other methods are available.

This is essential. Several sera must be used: the most positive sera, the last serum and the current sera if the patient has been transfused between the date of the last serum harvested and the CMX.

There is wide agreement on the requirement for quality surveillance of the recipient's immunological status. This policy is the only way to effectively select sera to cross-match before transplantation, whatever the technique used, and thus improve transplantation outcome and reduce the number of rejections.

These prerequisites hold for all organs, but especially so for renal (and/or pancreas) grafts. For heart or heart-lung transplantations, emergency procedures may be needed.