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Improving the performance of virtual crossmatch results by correlating with nationally-performed physical

Sean M Wrenn1, Carlos E Marroquin1, Donna-Sue Hain2

  • 1University of Vermont Robert Larner, M.D. College of Medicine, Department of Transplant Surgery, Burlington, VT, United States.

Human Immunology
|June 5, 2018
PubMed

Insights

Local mean fluorescence intensity (MFI) results for donor-specific HLA antibodies (DSA) can predict crossmatch outcomes. This study establishes a reliable model for predicting positive or negative crossmatches based on DSA MFI values in proficiency testing.

Area of Science:

  • Transplantation immunology
  • Clinical diagnostics
  • Immunogenetics

Background:

  • Donor-specific HLA antibodies (DSA) are critical in solid organ transplantation.
  • Predicting crossmatch outcomes based on DSA reactivity strength (mean fluorescence intensity, MFI) remains challenging.

Purpose of the Study:

  • To evaluate the predictive value of locally generated DSA MFI for crossmatch results.
  • To compare local MFI data with national proficiency testing outcomes.

Main Methods:

  • DSA MFI from single antigen beads were analyzed for proficiency testing samples (2011-2015).
  • Local MFI data was compared against aggregate positive crossmatch percentages from other laboratories.
  • Crossmatch methods included direct, antiglobulin-enhanced microcytotoxic (CDC-AHG), and flow cytometry.

Main Results:

  • Positive CDC-AHG and flow crossmatches correlated with specific MFI thresholds for HLA class I and II.
  • Low MFI (<3000) demonstrated high positive predictive values for negative crossmatches.
  • High MFI (>8000) showed high negative predictive values for positive crossmatches.

Conclusions:

  • Locally generated MFI results from proficiency testing reliably predict crossmatch outcomes.
  • This provides a replicable model for transplant centers to interpret DSA MFI.
  • Standardizing MFI interpretation enhances transplant safety and efficacy.
Abstract

Keywords:
AntibodiesBlood grouping and crossmatchingHLA antigensOrgan transplantationTransplantation immunology

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