Flow cytometry-detected IgG is not a contraindication to renal transplantation - IgM may be beneficial to outcome

被引：70

作者：

Kerman, RH ^{[1
]}

Susskind, B ^{[1
]}

Buyse, I ^{[1
]}

Pryzbylowski, P ^{[1
]}

Ruth, J ^{[1
]}

Warnell, S ^{[1
]}

Gruber, SA ^{[1
]}

Katz, S ^{[1
]}

Van Buren, CT ^{[1
]}

Kahan, BD ^{[1
]}

机构：

[1] Univ Texas, Sch Med, Dept Surg, Div Immunol & Organ Transplantat, Houston, TX 77030 USA

来源：

TRANSPLANTATION | 1999年 / 68卷 / 12期

关键词：

D O I：

10.1097/00007890-199912270-00007

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. At our transplant center, primary recipients of either a haplo-identical (haplo-ID) Living related (LRD) or a cadaveric (CAD) donor renal allograft are transplanted after a negative donor-specific IgG anti-human globulin (AHG) cross-match (XM). Testing included the historically highest panel-reactive antibody and the immediate (0-7 days) pretransplant sera. A positive donor specific IgM-AHG XM has not been a contraindication to transplant. Reports suggest that donor-specific now cytometry cross-matches (FCXM) may be more clinically informative than the AHG-XM. Methods. We therefore evaluated the impact of a positive FCXM (IgG or IgM) on the rejection frequency (0-12 months after transplant) and 1-year graft survival for cyclosporine-prednisone-treated primary (haplo-ID and CAD) renal allograft recipients. All transplants were performed after a negative donor-specific IgG AHG-XM regardless of the IgM-AHG XM status. Results. Rejection frequencies (26% vs. 31%, P=NS) and 1-year graft survivals (92% vs. 89%, P=NS) were comparable for haplo-ID LRD FCXM-negative and IgG-FCXM-positive recipients. However, IgM-FCXM-positive LRD recipients experienced significantly fewer rejections (13% vs. 26% P<0.02) and an improved 1-year graft survival (100% vs. 92%, P<0.02) than FCXM-negative LRD recipients. Similar results were observed for primary CAD recipients. Rejection frequencies (40% vs. 44%, P=NS) and 1-year graft survivals (83% vs. 81%, P=NS) were comparable for primary CAD FCXM-negative and IgG-FCXM-positive recipients. Again, IgM-FCXM-positive primary CAD recipients experienced significantly fewer rejections (22% vs, 40%, P<0.02) and improved 1-year graft survivals (89% vs. 83%, P<0.05) than FCXM-negative recipients. Conclusion. These data suggest that, after a negative donor-specific IgG-AHG XM, an IgG-positive FCXM is not a contraindication to transplantation. The presence of IgM may be beneficial in reducing the occurrence of rejection episodes and improving graft survivals.

引用

页码：1855 / 1858

页数：4

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