Related Experiment Videos
[Can one graft with a positive cross-match?]
E Alamartine1, S Acquart, L Absi
1Service de néphrologie, dialyse, transplantation rénale, Hôpital Nord, Saint-Etienne.
Nephrologie
|January 1, 1997
Summary
Differential cross-matching allows more kidney transplantations for immunized patients. This strategy, considering specific antibody profiles, shows graft survival rates identical to negative cross-matches, enabling successful transplantation in previously excluded candidates.
Area of Science:
- Immunology
- Nephrology
- Transplantation
Context:
- Traditional renal transplantation protocols exclude patients with positive cross-matches.
- Immunized patients with specific anti-donor antibodies face significant barriers to kidney grafting.
- Advancements in antibody characterization necessitate re-evaluation of cross-match protocols.
Purpose:
- To evaluate the safety and efficacy of differential cross-matching in renal transplantation.
- To assess graft survival rates in patients transplanted across positive cross-matches.
- To identify specific antibody characteristics influencing transplant outcomes.
Summary:
- A single-center study performed 79 renal transplantations across positive cross-matches (T and B cell).
- Antibody analysis included autoantibodies, IgM/IgG isotypes, and HLA specificities.
- Graft survival in positive cross-match recipients was comparable to negative cross-match controls, except for current positive B cell cross-matches due to IgG, which showed increased early graft failure risk.
Impact:
- Differential cross-matching is a safe strategy that expands eligibility for kidney transplantation in immunized populations.
- This approach permits successful grafting for patients previously excluded by global positive cross-match dogma.
- Further research into IgG-mediated positive B cell cross-matches is warranted to optimize outcomes.