Tissue Typing Laboratory, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Hills Road, Cambridge, United Kingdom.
Transplantation. 2010 Jan 27;89(2):185-93. doi: 10.1097/TP.0b013e3181c926f2.
A pretransplant lymphocyte crossmatch (XM) test is usually considered mandatory but may delay deceased donor renal transplantation. We report on the safety and clinical efficacy of omitting the XM when it is predicted to be negative based on sensitization history and human leukocyte antigen-specific antibody screening.
From 1998 to 2008, 606 deceased donor kidney transplants were performed at our center and the prospective donor-recipient XM omitted in 257 (42%). In all cases, a negative XM was confirmed retrospectively. Four hundred fourteen (68%) kidneys were donated after brain death (DBD) and 192 (32%) after cardiac death (DCD). The effect of this policy on cold ischemia time (CIT), delayed graft function (DGF), and transplant survival was assessed.
Mean CIT was 16.7 hr with a prospective XM and 14.3 hr when it was omitted (P<0.001). The beneficial effect of omitting the XM on DGF was only apparent in recipients of DBD kidneys, where the DGF rate was 28% with a prospective XM and 18% without a prospective XM (P=0.03). The corresponding DGF rate in recipients of DCD kidneys was 52% with a prospective XM and 54% without a prospective XM. Logistic regression analysis, after adjustment for variables that influenced DGF, showed that the odds on suffering DGF were lower when the pretransplant XM test was omitted (P=0.04). Neither acute rejection rate nor long-term graft survival was influenced by omission of the XM.
Rigorous recording of potential allosensitizing events and comprehensive antibody screening allows the XM to be safely omitted in selected patients and this helps limit CIT and may reduce DGF.
移植前淋巴细胞交叉配型（XM）试验通常被认为是强制性的，但可能会延迟已故供体肾移植。我们报告了基于致敏史和人类白细胞抗原特异性抗体筛查预测 XM 阴性时，安全省略 XM 的情况，并观察其临床疗效。
1998 年至 2008 年，我们中心进行了 606 例已故供体肾移植，其中 257 例（42%）前瞻性地省略了 XM。在所有情况下，均通过回顾性确认 XM 为阴性。411 例（68%）肾脏来自脑死亡（DBD）供体，192 例（32%）来自心脏死亡（DCD）供体。评估了这一政策对冷缺血时间（CIT）、延迟移植物功能（DGF）和移植存活率的影响。
前瞻性 XM 组的平均 CIT 为 16.7 小时，而省略 XM 时为 14.3 小时（P<0.001）。省略 XM 对 DGF 的有益影响仅在接受 DBD 肾脏的受者中明显，前瞻性 XM 组的 DGF 发生率为 28%，而没有前瞻性 XM 组的 DGF 发生率为 18%（P=0.03）。接受 DCD 肾脏的受者的相应 DGF 发生率为前瞻性 XM 组 52%，无前瞻性 XM 组 54%。多变量逻辑回归分析表明，在调整影响 DGF 的变量后，省略移植前 XM 检测时，发生 DGF 的可能性降低（P=0.04）。急性排斥反应率和长期移植物存活率均不受省略 XM 的影响。
严格记录潜在的同种致敏事件并进行全面抗体筛查，可安全地省略某些患者的 XM，有助于限制 CIT，并可能减少 DGF。
