Predictive Value of Pre-Transplant Cross-Match Techniques on Living Donor Kidney Transplant Outcomes.

M. Meneghini,¹ E. Melilli,¹ I. Revuelta,³ R. Rajalingam,² E. Rigol,⁴ S. Chandran,² F. Diekmann,³ F. Vincenti,² J. Cruzado,¹ J. Martorell,⁴ O. Bestard.¹

¹Kidney Transplant Unit, Bellvitge University Hospital
IDIBELL, Barcelona, Spain
²Kidney Transplant Unit, UCSF Medical Centre, SanFrancisco
³Kidney Transplant Unit, Clinic University Hospital, Barcelona, Spain
⁴Immunology Department, Clinic University Hospital, Barcelona, Spain

Meeting: 2017 American Transplant Congress

Abstract number: A231

Keywords: Alloantibodies, Graft failure, Kidney transplantation, Rejection

Session Information

Session Name: Poster Session A: Living Donor Kidney Transplant I

Session Type: Poster Session

Date: Saturday, April 29, 2017

Session Time: 5:30pm-7:30pm

Presentation Time: 5:30pm-7:30pm

Location: Hall D1

Study aim: To investigate the impact of different cross-match techniques and their combination before living-donor kidney transplantation(LDKT) on main clinical outcomes.

Methods: Retrospective study including 394 LDKT recipients from 2transplant centers in Barcelona(Spain) and 902LDKT as external validation cohort from San Francisco(CA). All AB0 compatible with negative pre-transplant CDC-crossmatch. Mean follow-up 69months. We evaluated 3 tests: B/T-cell Flow-cytometry-crossmatch(FCM), Solid-phase assay(Sp-DSA), complement binding DSA(DSA-C3d+).

Results: In the first cohort, 27/394(7%) were Sp-DSA+(7 class I, 13 II, 7 I&II; mean MFI9653±5903); 23(6%) FCM+ and 17(4%) DSA-C3d+. Out of 27 Sp-DSA+ patients, 14(52%) displayed FCM+(anti-T and B), no difference in mean Sp-DSAMFI compared to FCM-group.

72/902(8%) LDKT of the external cohort showed sp-DSA+(mean MFI 5957±5595): 24 class I, 37 II, 7 I&II. 24/72(33%) showed FCM+(4 anti-T, 7 B, 13 T&B) no differences regarding Sp-DSAMFI.

DSA-C3d+ showed significantly higher MFI(mean 12046±5570,p<0.001) and a cut-off of 6192 predicted C3d positivity(AUC=0.84).

The multivariate analysis predicting AR, revealed that DSA-C3d+(HR19.58, p=0.016) and DSAMFI>6190(HR22.38, p 0.019) were the only independent predictors. While the univariate analysis for graft loss showed that a FCM+(HR5.02, p=0.002), Sp-DSA+(HR2.99,p=0.042) and previous AR(HR 10.63,p<0.001) were associated, in the multivariate analysis only previous AR(HR9.48, p=0.011) independently predicted outcome.

Conclusions: Preformed DSA-C3d+ or high MFI Sp-DSA are best predictors of AR, which in turn is the solely independent variable predicting high risk of graft loss. A virtual cross-match using Sp-DSA is the most useful immune tool to predict AR and thus, patients at increased risk of premature graft loss.

CITATION INFORMATION: Meneghini M, Melilli E, Revuelta I, Rajalingam R, Rigol E, Chandran S, Diekmann F, Vincenti F, Cruzado J, Martorell J, Bestard O. Predictive Value of Pre-Transplant Cross-Match Techniques on Living Donor Kidney Transplant Outcomes. Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Meneghini M, Melilli E, Revuelta I, Rajalingam R, Rigol E, Chandran S, Diekmann F, Vincenti F, Cruzado J, Martorell J, Bestard O. Predictive Value of Pre-Transplant Cross-Match Techniques on Living Donor Kidney Transplant Outcomes. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/predictive-value-of-pre-transplant-cross-match-techniques-on-living-donor-kidney-transplant-outcomes/. Accessed November 25, 2024.

« Back to 2017 American Transplant Congress