Home About us Current issue Back issues Submission Instructions Advertise Contact Login   

Search Article 
  
Advanced search 
 
Saudi Journal of Kidney Diseases and Transplantation
Users online: 1901 Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size 

ORIGINAL ARTICLE Table of Contents   
Year : 2009  |  Volume : 20  |  Issue : 4  |  Page : 577-589
Crossmatch testing in kidney transplantation: Patterns of practice and associations with rejection and graft survival


1 Division of Abdominal Organ Transplantation, Department of Surgery, Saint Louis University Medical Center and Saint Louis University Medical Center Histocompatibility and Immunology Laboratory and Saint Louis University Center for Outcomes Research (SLUCOR), USA
2 Division of Abdominal Organ Transplantation, Department of Surgery, Saint Louis University Medical Center and Saint Louis University Medical Center Histocompatibility and Immunology Laboratory, USA
3 Saint Louis University Center for Outcomes Research (SLUCOR), USA
4 Division of Abdominal Organ Transplantation, Department of Surgery, Saint Louis University Medical Center, USA
5 Saint Louis University Center for Outcomes Research (SLUCOR) and Division of Nephrology, Saint Louis University School of Medicine, St. Louis, MO, USA

Correspondence Address:
Krista L Lentine
Saint Louis University Center for Outcomes Research Salus Center, 2nd Floor 3545 Lafayette Ave St. Louis, MO 63130
USA
Login to access the Email id


PMID: 19587497

Rights and Permissions

Methods of crossmatch testing prior to kidney transplantation are not standardized and there are limited large-scale data on the use and outcomes implications of crossmatch modality. Data describing the most sensitive crossmatch modality for crossmatch-negative kidney transplants were drawn from the Organ Procurement and Transplant Network Registry. Within the cohort transplanted in 1999-2005, we identified patient and transplant characteristics predictive of each testing modality by multivariate logistic regression. We assessed associations of crossmatch modality with rejection risk by logistic regression and with graft survival by Cox's hazards analysis. Among 230,995 transplants, use of flow cytometry with T-and B-lymphocytes (T&B FC) increased progressively in 1987-2005. Among the recent transplants performed in 1999-2005 (n=64,320), negative T&B FC crossmatch was associated with 15% lower relative risk of first-year acute rejection (adjusted HR 0.85, 95% CI 0.80-0.89) compared to negative T-antihuman-globulin and B-National Institutes of Health/Wash (T AHG &B) crossmatch. Five-year graft survival after transplant with negative T&B FC (82.6%) was modestly better than after negative T AHG &B (81.4%, P= 0.008) or T AHG crossmatch (81.1%, P< 0.0001), but on adjusted analysis was significantly different only among recipients from deceased donors and patients aged > 60 years. Many subgroups for whom negative T&B FC crossmatch predicted lower rejection risk (Caucasians, deceased donor recipients, re-transplants) were not more likely to be crossmatched by this method. We conclude that current practice patterns have not aligned utilization of T&B FC crossmatch with associated benefits. Prospective evaluation of the relationship of crossmatch modality with outcomes is warranted.


[FULL TEXT] [PDF]*
Print this article  Email this article
    

  Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
   Citation Manager
  Access Statistics
   Reader Comments
   Email Alert *
   Add to My List *
 * Requires registration (Free)
 

 Article Access Statistics
    Viewed4589    
    Printed95    
    Emailed0    
    PDF Downloaded722    
    Comments [Add]    
    Cited by others 1    

Recommend this journal