Introduction: Complement Dependent Cytotoxic (CDC) (non-augmented) cross matching and Flow cytometric (FC) cross matching are two commonly used techniques to identify anti- Human Leucocyte Antigen (HLA) antibodies. Preformed antibodies cause rejection by binding to HLA antigens expressed on the endothelium of vessels in the transplanted kidney. It has been shown by Higgins etal that transplanting across HLA incompatibility has good outcomes if CDC crossmatch was negative. In that study, death censored graft survival in the CDC negative (but DSA positive) group was 88.6% compared to 54.2% in the CDC positive group.

The aim of this study is to look at the predictive value of pre-treatment CDC titres in relation to graft survival.

Materials and Methods: We performed a retrospective analysis of 27 antibody Incompatible Transplant (AiT) recipients, done at a single centre, between 2004 and 2013, with a positive pre-treatment CDC cross match. We looked at their pre and post treatment titres, comparing them with flow cytometric RMF values, to establish criteria to proceed for transplantation post treatment and to determine the level of positive titres that predict subsequent rejection.

Results: Out of the 27 pre-treatment CDC cross match positive renal transplant recipients, only 26 were transplanted. 1 had positive post-treatment CDC and FC values, and did not proceed to transplantation. 17 out of 26 patients (65.38%) had rejection: Out of the 17, 15 (88.2%) had acute antibody mediated rejection within 3 months and 2 (11.76%) developed chronic transplant glomerulopathy. Ten of the 17 (58.82%) had pre-treatment titres of >1 and seven (41.17%) had low titres of 1. However, five of the seven had significantly positive post treatment flow cross match RMF values.

Nine of the 26 did not reject; six of the nine (66.66%) patients had low pre-treatment titres of 1.

Conclusion: This study, shows an encouraging trend where, if the pre-treatment CDC titres were low, the chances of graft loss was low. However larger numbers and a complete data set are needed before we can make a stronger correlation.

CITATION INFORMATION: Prasad A, Yuvaraj A, Briggs D, Krishnan N. Can Pre-Treatment CDC Titres Predict Graft Outcomes in HLA Incompatible Transplants? Am J Transplant. 2017;17 (suppl 3).

« Back to 2017 American Transplant Congress