BACKGROUND: The significance of a positive B-cell crossmatch (BCM) in kidney transplantation has always been controversial in the evaluation of its implications on graft survival and specificity of the antibodies involved. METHODS: We have investigated the sera of 62 recipients of a kidney allograft transplanted across a positive BCM (T negative) for the presence of autoantibodies and anti-human leukocyte antigen (HLA) class I and II antibodies, using a combination of lymphocytotoxicity, enzyme-linked immunosorbent assay (ELISA), and flow cytometry tests. The controls were the 930 patients transplanted over the same period of time with a negative T and BCM. RESULTS: Autoantibodies were detected in 16%, and donor specific anti-HLA class II antibodies, mainly DQ, in 23% of the patients. None had antibodies against donor HLA class I. The target of the antibodies was not identified in 61%. Graft survival was comparable in the controls and in the +BCM patients, with nondonor-specific HLA reactivity. Patients with donor-specific anti-HLA class II antibodies had lower early graft survival and a higher incidence of vascular rejection. However, long-term allograft survival was similar to that of the other groups. CONCLUSION: These data suggest that in 77% of the patients, BCM positivity was not related with anti-HLA antibodies, and, in this case, graft survival was similar to that of the -BCM controls. In a minority of patients, anti-HLA class II antibodies were responsible for the +BCM, and their presence was associated with lower early, but not long-term, graft survival. Consequently, a +BCM should not systematically contraindicate kidney transplantation.
BACKGROUND: The significance of a positive B-cell crossmatch (BCM) in kidney transplantation has always been controversial in the evaluation of its implications on graft survival and specificity of the antibodies involved. METHODS: We have investigated the sera of 62 recipients of a kidney allograft transplanted across a positive BCM (T negative) for the presence of autoantibodies and anti-human leukocyte antigen (HLA) class I and II antibodies, using a combination of lymphocytotoxicity, enzyme-linked immunosorbent assay (ELISA), and flow cytometry tests. The controls were the 930 patients transplanted over the same period of time with a negative T and BCM. RESULTS: Autoantibodies were detected in 16%, and donor specific anti-HLA class II antibodies, mainly DQ, in 23% of the patients. None had antibodies against donor HLA class I. The target of the antibodies was not identified in 61%. Graft survival was comparable in the controls and in the +BCM patients, with nondonor-specific HLA reactivity. Patients with donor-specific anti-HLA class II antibodies had lower early graft survival and a higher incidence of vascular rejection. However, long-term allograft survival was similar to that of the other groups. CONCLUSION: These data suggest that in 77% of the patients, BCM positivity was not related with anti-HLA antibodies, and, in this case, graft survival was similar to that of the -BCM controls. In a minority of patients, anti-HLA class II antibodies were responsible for the +BCM, and their presence was associated with lower early, but not long-term, graft survival. Consequently, a +BCM should not systematically contraindicate kidney transplantation.
Authors: Enver Akalin; Rajani Dinavahi; Rex Friedlander; Scott Ames; Graciela de Boccardo; Vinita Sehgal; Bernd Schröppel; Madhu Bhaskaran; Susan Lerner; Marileno Fotino; Barbara Murphy; Jonathan S Bromberg Journal: Clin J Am Soc Nephrol Date: 2008-03-12 Impact factor: 8.237
Authors: Christopher K Burghuber; Miriam Manook; Brian Ezekian; Adriana C Gibby; Frank V Leopardi; Minqing Song; Jennifer Jenks; Frances Saccoccio; Sallie Permar; Alton B Farris; Neal N Iwakoshi; Jean Kwun; Stuart J Knechtle Journal: Am J Transplant Date: 2018-09-17 Impact factor: 8.086
Authors: Hyeon Seok Hwang; Hye Eun Yoon; Bum Soon Choi; Eun Jee Oh; Ji Il Kim; In Sung Moon; Yong Soo Kim; Chul Woo Yang Journal: J Korean Med Sci Date: 2011-03-28 Impact factor: 2.153
Authors: Juan C Scornik; Jonathan S Bromberg; Douglas J Norman; Mayank Bhanderi; Matthew Gitlin; Jeffrey Petersen Journal: BMC Nephrol Date: 2013-10-10 Impact factor: 2.388