Bingaman Adam W, Murphey Cathi L, Palma-Vargas Juan, Wright Francis
Texas Transplant Institute, Methodist Specialty and Transplant Hospital, San Antonio, TX 78229, USA.
Transplantation. 2008 Dec 27;86(12):1864-8. doi: 10.1097/TP.0b013e318191404c.
Patients with preexisting antihuman leukocyte antigen (HLA) antibodies (sensitized patients) are more likely to have a positive crossmatch with possible donors and have a lower likelihood of receiving a renal transplant with longer wait times. A virtual crossmatch protocol using solid-phase technology to determine the specificity of anti-HLA antibodies may improve the probability of identifying a crossmatch-negative compatible donor and increase access of sensitized patients to kidney transplantation.
A virtual crossmatch protocol was implemented on October 1, 2006 with solid-phase HLA antibody characterization for all sensitized patients on the waiting list. Transplant rates for the period from October 2006 to June 2008 were compared with Scientific Registry of Transplant Recipients (SRTR) data from 2006 to determine national transplant rates for sensitized patients.
SRTR data for 2006 showed that nationally 590 of 10,659 transplants (5.5%) were in-patients with panel reactive antibody (PRA) more than or equal to 80%. During 2006 to 2008, after initiation of the virtual crossmatch protocol, we performed 122 deceased donor kidney transplants, of which 15 (12.3%) sensitized patients (PRA>or=80%) received transplants (P=0.004 compared with SRTR national data), with 9 (7.4%) patients having a PRA more than 90%. The virtual crossmatch protocol was predictive of a negative-final crossmatch and eliminated the use of preliminary cross-matching with attendant cost savings of more than $100,000.
Initiation of a virtual crossmatch protocol using solid-phase histocompatibility techniques significantly increased access of sensitized patients to kidney transplantation and was more cost effective. Usage of a virtual crossmatch may facilitate greater sharing of kidneys to improve access to transplantation for sensitized recipients.
预先存在抗人类白细胞抗原（HLA）抗体的患者（致敏患者）与潜在供体的交叉配型更有可能呈阳性，接受肾移植的可能性较低，等待时间更长。使用固相技术确定抗HLA抗体特异性的虚拟交叉配型方案可能会提高识别交叉配型阴性相容供体的概率，并增加致敏患者接受肾移植的机会。
2006年10月1日实施了虚拟交叉配型方案，对等待名单上的所有致敏患者进行固相HLA抗体鉴定。将2006年10月至2008年6月期间的移植率与2006年移植受者科学注册系统（SRTR）的数据进行比较，以确定致敏患者的全国移植率。
2006年SRTR数据显示，全国10659例移植中有590例（5.5%）是群体反应性抗体（PRA）大于或等于80%的住院患者。在2006年至2008年期间，虚拟交叉配型方案启动后，我们进行了122例尸体供肾移植，其中15例（12.3%）致敏患者（PRA≥80%）接受了移植（与SRTR全国数据相比，P=0.004），9例（7.4%）患者的PRA超过90%。虚拟交叉配型方案可预测最终交叉配型为阴性，并消除了初步交叉配型的使用，节省了超过10万美元的相关费用。
采用固相组织相容性技术启动虚拟交叉配型方案显著增加了致敏患者接受肾移植的机会，且更具成本效益。使用虚拟交叉配型可能有助于更广泛地共享肾脏，以改善致敏受者的移植机会。
