Pelletier R P, Orosz C G, Adams P W, Bumgardner G L, Davies E A, Elkhammas E A, Henry M L, Ferguson R M
Department of Surgery, The Ohio State University Medical Center, Columbus 43210, USA.
Transplantation. 1997 Jun 15;63(11):1639-45. doi: 10.1097/00007890-199706150-00018.
We retrospectively compared the clinical and financial impact of a final cross-match by T cell flow cytometry (FXM) versus conventional complement-dependent cytotoxicity (CXM) in consecutive primary cadaveric kidney (K) and primary simultaneous cadaveric pancreas-kidney (SPK) transplant recipients. Mean follow-up was 14 months for both the K (range, 5-22 months) and SPK (range, 5-22 months) recipients. There were no instances of a positive CXM result if the FXM result was negative. However, 18 of the 102 (18%) K recipients and 11 of the 66 (17%) SPK recipients were FXM positive, CXM negative, but no grafts lost to hyperacute rejection in this group. In addition, patient survival, graft survival, incidence of acute rejection, and kidney and pancreas function (immediate and late) were not different in the FXM-positive versus the FXM-negative groups. Charges for the CXM and FXM methods were compared over a 6-month period. During that period, the FXM charges averaged $583 less per recipient than the CXM charges (58% reduction in charges), and the time required to perform the FXM method was 50% of that required for the CXM method. These results demonstrate that a clinical pathway for primary transplantation that utilizes the FXM rather than the CXM final cross-match is clinically safe, with no adverse effect on posttransplant outcome, reduces organ preservation time by shortening the waiting period for the final cross-match results, and significantly reduces the tissue typing charges. However, about 9% of all primary K and SPK recipients will be FXM positive, CXM negative on final cross-match and will be unnecessarily denied a transplant. In this study, we describe a method to identify these patients so that they can be tested by traditional CXM to avoid being denied access to donor organs.
我们回顾性比较了连续的初次尸体肾（K）移植受者和初次同时尸体胰肾（SPK）移植受者中，通过T细胞流式细胞术进行最终交叉配型（FXM）与传统补体依赖细胞毒性试验（CXM）的临床和经济影响。K组和SPK组受者的平均随访时间均为14个月（范围为5 - 22个月）。若FXM结果为阴性，则不存在CXM结果为阳性的情况。然而，102例K组受者中有18例（18%）、66例SPK组受者中有11例（17%）FXM结果为阳性、CXM结果为阴性，但该组中无移植物因超急性排斥反应而丢失。此外，FXM阳性组与FXM阴性组在患者生存率、移植物生存率、急性排斥反应发生率以及肾脏和胰腺功能（即刻和远期）方面并无差异。对CXM和FXM方法在6个月期间的费用进行了比较。在此期间，FXM的费用平均每位受者比CXM少583美元（费用降低了58%），且进行FXM方法所需时间为CXM方法所需时间的50%。这些结果表明，在初次移植中采用FXM而非CXM进行最终交叉配型的临床路径在临床上是安全的，对移植后结局无不良影响，通过缩短等待最终交叉配型结果的时间减少了器官保存时间，并显著降低了组织配型费用。然而，所有初次K组和SPK组受者中约9%在最终交叉配型时FXM结果为阳性、CXM结果为阴性，将被不必要地拒绝移植。在本研究中，我们描述了一种识别这些患者的方法，以便他们能够通过传统的CXM进行检测，从而避免被拒绝获得供体器官。
