Division of Transplant Surgery, Medical University of South Carolina, Charleston, SC.
Division of Transplant Surgery, Medical University of South Carolina, Charleston, SC..
J Am Coll Surg. 2020 Apr;230(4):373-379. doi: 10.1016/j.jamcollsurg.2019.12.031. Epub 2020 Feb 5.
Flow cytometric crossmatching is currently the method of choice for most transplantation programs before kidney transplantation. In July of 2017, our program implemented the virtual crossmatch, without a prospective physical crossmatch, for the majority of patients in the setting of a new kidney allocation system implemented by the United Network for Organ Sharing.
A retrospective review was conducted to determine whether virtual crossmatching could reduce cold ischemia time (CIT). Secondary outcomes included the incidence of delayed graft function and 1-year patient and allograft failure.
A total of 825 patients received a kidney transplant between December 1, 2014 and July 1, 2018; 505 were in the pre-implementation group and 227 were in the post-implementation group. The CIT decreased between the pre-implementation era to post implementation era from 16.67 ± 8.7 hours to 14.5 ± 8.2 hours (p = 0.002). On univariate analysis, delayed graft function (DGF) rates were similar between the 2 eras (19% vs 17%; p = 0.415), despite having more donations after cardiac death and higher Kidney Donor Profile Index donors in the post-implementation era. There was no difference in biopsy-proven acute rejection (n = 28 [5.6%] vs n = 8 [3.5%]; p = 0.226), 1-year graft loss (4% vs 3%; p = 0.304), or patient death (2% vs 1%; p = 0.567) rate between groups. On multivariable modeling for mean CIT and incidence of DGF, patients receiving transplants in the post-implementation era had an adjusted reduction in CIT of an estimated 2.35 hours (95% CI, 1.15 to 3.55; p < 0.001). Patients in the post-implementation era also had 26% lower odds of DGF developing (odds ratio 0.74; 95% CI, 0.48 to 1.14; p = 0.170), after adjusting for covariates.
Kidney transplantation can be safely performed with virtual crossmatching, without a prospective physical crossmatch with improved CIT and potentially reduced DGF rate without increased risk of rejection.
流式细胞交叉配型目前是大多数移植项目在进行肾移植前的首选方法。2017 年 7 月，我们的项目在由器官共享联合网络实施的新的肾脏分配系统中，为大多数患者实施了虚拟交叉配型，而无需进行前瞻性物理交叉配型。
回顾性研究旨在确定虚拟交叉配型是否可以减少冷缺血时间（CIT）。次要结局包括延迟移植物功能障碍和 1 年患者和移植物失败的发生率。
2014 年 12 月 1 日至 2018 年 7 月 1 日期间，共有 825 例患者接受了肾移植；505 例患者在实施前组，227 例患者在实施后组。与实施前相比，CIT 在实施后从 16.67±8.7 小时降至 14.5±8.2 小时（p=0.002）。单因素分析显示，两个时期的延迟移植物功能障碍（DGF）发生率相似（19%比 17%；p=0.415），尽管在后实施时期有更多的心脏死亡后供体和更高的肾脏供体评分供体。活检证实的急性排斥反应（n=28[5.6%]比 n=8[3.5%]；p=0.226）、1 年移植物丢失（4%比 3%；p=0.304）或患者死亡（2%比 1%；p=0.567）率在两组之间无差异。在对平均 CIT 和 DGF 发生率进行多变量建模时，在后实施时期接受移植的患者 CIT 估计减少了 2.35 小时（95%CI，1.15 至 3.55；p<0.001）。在后实施时期，DGF 发生的几率也降低了 26%（优势比 0.74；95%CI，0.48 至 1.14；p=0.170），调整了协变量。
肾移植可以安全地进行虚拟交叉配型，无需进行前瞻性物理交叉配型，CIT 得到改善，潜在的 DGF 发生率降低，而排斥反应的风险增加。
