Successful transplantation with a positive T and B cell crossmatch due to autoreactive antibodies.

A total of 16 cadaver donor renal allografts have been performed in the presence of a positive T and B cell crossmatch due to autoantibodies. Fourteen of these patients were considered to be highly-sensitized, in that they had pregraft antibodies reacting with more than 85% of the lymphocyte panel. Ten of the 16 grafts are still functioning with follow-up times of between 3 and 66 months. Within the same time period three living related donor transplants were also performed with a positive T and B cell crossmatch due to autoantibodies. Two were from HLA-identical siblings and the other from his father. All three patients had pregraft antibodies reacting with 100% of the lymphocyte panel. All grafts are functioning normally between 9 and 48 months after transplantation. Autoreactive T and B cell antibodies are not damaging to renal allografts and recognition of these antibodies allows a significant number of patients to be successfully transplanted (with a positive crossmatch).