Long-term graft survival is improved in cadaveric renal retransplantation by flow cytometric crossmatching

被引:63
作者
Bryan, CF
Baier, KA
Nelson, PW
Luger, AM
Martinez, J
Pierce, GE
Ross, G
Shield, CF
Warady, BA
Aeder, MI
Helling, TS
Muruve, N
机构
[1] Midwest Organ Bank Inc, HCLD, Westwood, KS 66205 USA
[2] Univ Missouri Hosp & Clin, Columbia, MO 65212 USA
[3] St Johns Reg Med Ctr, Joplin, MO 64804 USA
[4] Univ Kansas, Med Ctr, Kansas City, KS 66160 USA
[5] Via Christi St Francis Reg Med Ctr, Wichita, KS 67201 USA
[6] Childrens Mercy Hosp, Kansas City, MO 64108 USA
[7] Res Med Ctr, Kansas City, MO 64132 USA
关键词
D O I
10.1097/00007890-199812270-00043
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. Cadaveric renal retransplantation is associated with a higher risk of early graft failure than primary grafts. A large proportion of those graft losses is likely attributable to donor-directed HLA class I antibodies, detectable by flow cytometry crossmatching but not by conventional crossmatching techniques. Methods. Long-term graft survival in a group of 106 recipients of consecutive cadaveric renal regrafts between 1990 and 1997, in whom a negative flow T-cell IgG; crossmatch was required for transplantation, was compared with two other groups of cadaveric transplant recipients. The first group consisted of 174 cadaveric regrafts transplanted between 1985 and 1995 using only a negative anti-human globulin (AHG) T-cell IgG crossmatch. The second group was primary cadaveric transplants done concurrently with the flow group (1990 to 1997) using only the AHG T-cell IBG; crossmatch. Results. The long-term (7 year) graft survival rate of flow crossmatch-selected regraft recipients (68%; n=106) was significantly improved over that of regraft recipients who were selected for transplantation by only the AHG crossmatch technique (45%; n=174; log-rank=0.001; censored for patients dying with a functioning graft). Graft outcome for the flow crossmatched regraft recipients was not significantly different from that of primary cadaveric patients (72%; n=889; log-rank=0.2; censored for patients dying with a functioning graft). Finally, a positive B-cell IgG flow cytometric crossmatch had no influence on long-term regraft outcome. Conclusions. The use of the flow T-cell IgG; crossmatch as the exclusion criterion for cadaveric renal retransplantation yields an improved long-term graft outcome over that obtained when only the AHG crossmatch is used and has improved survival of regraft recipients to the level of our primary cadaveric renal transplant population.
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收藏
页码:1827 / 1832
页数:6
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