Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC, USA.
Am J Transplant. 2012 Dec;12 Suppl 4:S33-42. doi: 10.1111/j.1600-6143.2012.04238.x. Epub 2012 Sep 4.
We evaluated virtual crossmatching (VXM) for organ allocation and immunologic risk reduction in sensitized isolated intestinal transplantation recipients. All isolated intestine transplants performed at our institution from 2008 to 2011 were included in this study. Allograft allocation in sensitized recipients was based on the results of a VXM, in which the donor-specific antibody (DSA) was prospectively evaluated with the use of single-antigen assays. A total of 42 isolated intestine transplants (13 pediatric and 29 adult) were performed during this time period, with a median follow-up of 20 months (6-40 months). A sensitized (PRA ≥ 20%) group (n = 15) was compared to a control (PRA < 20%) group (n = 27) to evaluate the efficacy of VXM. With the use of VXM, 80% (12/15) of the sensitized patients were transplanted with a negative or weakly positive flow-cytometry crossmatch and 86.7% (13/15) with zero or only low-titer (≤ 1:16) DSA. Outcomes were comparable between sensitized and control recipients, including 1-year freedom from rejection (53.3% and 66.7% respectively, p = 0.367), 1-year patient survival (73.3% and 88.9% respectively, p = 0.197) and 1-year graft survival (66.7% and 85.2% respectively, p = 0.167). In conclusion, a VXM strategy to optimize organ allocation enables sensitized patients to successfully undergo isolated intestinal transplantation with acceptable short-term outcomes.
我们评估了虚拟交叉配型（VXM）在致敏性孤立肠移植受者中的器官分配和免疫风险降低作用。本研究纳入了 2008 年至 2011 年我院进行的所有孤立肠移植。致敏受者的同种异体移植分配基于 VXM 的结果，其中使用单抗原检测法前瞻性评估供体特异性抗体（DSA）。在此期间共进行了 42 例孤立肠移植（儿童 13 例，成人 29 例），中位随访时间为 20 个月（6-40 个月）。将致敏（PRA≥20%）组（n=15）与对照组（PRA<20%）（n=27）进行比较，以评估 VXM 的效果。使用 VXM，80%（12/15）的致敏患者进行了阴性或弱阳性流式细胞交叉配型，86.7%（13/15）为零或仅低滴度（≤1:16）DSA。致敏和对照组受者的结果相似，包括 1 年无排斥反应的发生率（分别为 53.3%和 66.7%，p=0.367）、1 年患者生存率（分别为 73.3%和 88.9%，p=0.197）和 1 年移植物生存率（分别为 66.7%和 85.2%，p=0.167）。总之，优化器官分配的 VXM 策略使致敏患者能够成功进行孤立肠移植，并获得可接受的短期结果。
