Date: Tuesday, June 4, 2019
Session Name: Concurrent Session: Kidney Deceased Donor Allocation III
Session Time: 2:30pm-4:00pm
Presentation Time: 2:54pm-3:06pm
Location: Ballroom B
*Purpose: Virtual crossmatch (VXM) using Luminex single antigen bead has significantly improved prediction of an actual negative crossmatch. A negative crossmatch is typically required for allocating donor kidneys and to reduce the risk of acute rejection. Pre-transplant crossmatch testing, such as complement dependent cytotoxicity crossmatch or flow cytometry crossmatch (FCXM) may, however, delay deceased donor renal transplantation (DDRT) and possibly affect allograft outcomes. We evaluated the safety of only using VXM pre-transplant without waiting for actual crossmatch to allocate DDRT.
*Methods: n our center, we initiated a protocol to allocate kidneys for DDRT based on VXM in 2015. The protocol, however, called for a FCXM on the first post-operative day. Between August 2010 and August 2017 we did 46 DDRT, of which 21 (45%) recipients only underwent pre-transplant VXM (group A). For the remaining 25 FCXM was done prior to allocation and transplantation (group B). Basiliximab was used for induction in 19 (90%) and 25 (100%) recipients in group A and group B, respectively (P=0.2). There were no extended donor kidneys in group B and 2 (10%) kidneys in group A (P=0.2). We evaluated the effect of this protocol on cold ischemia time (CIT), delayed graft function (DGF), acute rejection (AR) and graft survival within first year post-transplant.
*Results: The FCXM was negative in all cases (group A and B). There was a significant reduction of CIT by more than 6 hours (P=0.0001) in group A (mean 9±4 hours) compared to group B (mean 18±5 hours). Three (12%) of the patients in group B developed DGF, while none in group A (P=0.2). There was no AR within first year occurred in either groups. One-year and 3-year graft survival rates were 100% vs. 96% and 88% vs. 92% (P=0.7), in group A and B, respectively.
*Conclusions: Use of pre-transplant VXM for DDRT allocation and transplantation reduces duration of CIT and can reduce incidence of DGF without increasing risk of AR or affecting graft survival.
To cite this abstract in AMA style:Abuhelaiqa E, Alkadi M, Thappy S, Saleh S, Mahmoud J, Jarman M, Fituri O, Elkhalifa M, Wadström J, Al-Malki H. The Effect Of Exclusive Virtual Crossmatch To Allocate Deceased Donor Kidney Transplant On Cold Ischemia Time And Acute Rejection [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/the-effect-of-exclusive-virtual-crossmatch-to-allocate-deceased-donor-kidney-transplant-on-cold-ischemia-time-and-acute-rejection/. Accessed December 13, 2019.
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