Purpose: Determine outcomes of positive crossmatch (PXM) renal transplant recipients that failed to convert to negative flow cytometry crossmatch (FCXM) despite desensitization.

Methods: All patients that underwent desensitization prior to a PXM transplant between 1/1/00 and 11/1/11 were identified for analysis. Patients who underwent transplantation despite failure to convert to negative FCXM were identified as the PXM group. Negative XM (NXM) was defined by a negative standard XM and a Tcell < +19mcs and a Bcell < +30mcs on FCXM. Patients who converted to NXM after desensitization comprised the converted group. The primary endpoint is difference in mean GFR at 3 mos, 6 mos, 1 yr, and 3 yrs. Other outcome measures include: survival, rejection episodes, infection.

Results: 108 patients were desensitized prior to PXM renal transplant. 42 failed to convert to negative FCXM (PXM group) prior to transplantation. Control (converted) group consisted of 66 patients.

Conclusions: GFR was significantly lower in the PXM group compared to the converted group at discharge and 1 yr. A significantly higher percentage of the PXM group had a GFR< 30 mL/min at 1 yr. Numerically higher rates of BPAMR, BPACR, empiric rejection were seen in the PXM group, and a significantly higher incidence BPACR was seen in the positive final B cell FCXM subgroup versus those who converted to negative B cell FCXM at 1 yr. However, 1 and 3 yr graft and patient survival remained comparable. Opportunistic infections were also similar between groups.

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