Multicenter evaluation of a novel endothelial cell crossmatch test in kidney transplantation
Alloantibodies; Crossmatch; Endothelium; Histocompatibility; Humoral allograft rejection; Kidney transplantation
BACKGROUND.: Despite their clinical importance, clinical routine tests to detect anti-endothelial cell antibodies (AECA) in organ transplantation have not been readily available. This multicenter prospective kidney transplantation trial evaluates the efficacy of a novel endothelial cell crossmatch (ECXM) test to detect donor-reactive AECA associated with kidney allograft rejection. METHODS.: Pretransplant serum samples from 147 patients were tested for AECA by a novel flow cytometric crossmatch technique (XM-ONE) using peripheral blood endothelial progenitor cells as targets. Patient enrolment was based on acceptance for transplantation determined by donor lymphocyte crossmatch results. RESULTS.: Donor-reactive AECA were found in 35 of 147 (24%) patients. A significantly higher proportion of patients with a positive ECXM had rejections (16 of 35, 46%) during the follow-up of at least 3 months compared with those without AECA (13 of 112, 12%; P<0.00005). Both IgG and IgM AECAs were associated with graft rejections. Mean serum creatinine levels were significantly higher in patients with a positive ECXM test at 3 and 6 months posttransplant. CONCLUSIONS.: XM-ONE is quick, easy to perform on whole blood samples and identifies patients at risk for rejection and reduced graft function not identified by conventional lymphocyte crossmatches. © 2009 by Lippincott Williams & Wilkins.
Breimer, M., Rydberg, L., Jackson, A., Lucas, D., Zachary, A., Melancon, J., Von Visger, J., Pelletier, R., Saidman, S., Williams, W., Holgersson, J., Tydén, G., Klintmalm, G., Coultrup, S., Sumitran-Holgersson, S., & Grufman, P. (2009). Multicenter evaluation of a novel endothelial cell crossmatch test in kidney transplantation. Transplantation, 87 (4). http://dx.doi.org/10.1097/TP.0b013e3181949d4e