Successful cadaver kidney transplantation in patients highly sensitized by blood transfusions. Unimportance of the most reactive serum in the pretransplant crossmatch.

Six patients who underwent a prospective blood transfusion protocol developed antibodies reactive with 41-95% of a lymphocyte panel. These antibodies disappeared 9-18 months later, and all six patients were successfully transplanted with cadaver kidneys in spite of positive crossmatches with donor T and B cells using their most reactive noncurrent sera. Crossmatches with their current sera were negative. No patient underwent plasmapheresis, blood transfusions, or immunosuppression between the time of maximum panel reactivity and transplantation. Graft survival was 100% after a mean of 22.3 months, and the mean serum creatinine level was 2.1 mg/dl one year after grafting. A positive anti-donor T or warm B cell crossmatch with the most reactive serum may be disregarded if the most recent serum is crossmatch-negative with a cadaver kidney transplant donor.