IMPROVED SURVIVAL AND FUNCTION OF RENAL-TRANSPLANTS WITH POSITIVE B-CELL CROSSMATCHES

A T cell crossmatch technique has been used as the definitive crossmatch in 78 cadaveric transplants. Thirty of these recipients had a positive B cell crossmatch. Two grafts were lost because of rejection in the positive B cell crossmatch group and 15 were irreversibly rejected in the negative B cell crossmatch group. The actuarial survival of the positive B cell crossmatch group was significantly higher than that of the negative B cell crossmatch group. These results occurred despite a higher incidence of presensitisation and worse HLA matching in the B cell positive group. There was no indication that the benefical effect of specific antidonor B cell presensitisation was related to the optimal temperature of reactivity of the recipients' sera, as has been suggested by others. Data on pretransplant blood transfusion was available for all patients who received transplants at one hospital. Those recipients with positive B cell crossmatches received significantly more blood and had significantly better graft survivals than those with negative B cell crossmatches. A positive B cell crossmatch may be a marker for a state of active enhancement of a recipient for a particular donor kidney, and the antibodies causing the positive B cell crossmatch may be one of several possible mechanisms in the observed improved graft survival in these patients.