RESUMO
These data suggest the presence of virtual crossmatch positive, low titer donor specific anti-human leukocyte antigen antibody (DSA) positive sera does not guarantee that real-time crossmatches will be positive. DSA that are present at an undiluted concentration but absent at a 1:8 or 1:16 dilution may not have to be considered unacceptable. This would allow potential recipients wider access to donor organs by reducing the number of listed unacceptable antigens. It also calls into question the use of virtual crossmatching, which may be disenfranchising minorities. Finally, evaluation of antibody concentration by dilution or titer may be clinically more useful than mean fluorescence intensity.
Assuntos
Autoanticorpos/imunologia , Rejeição de Enxerto/imunologia , Antígenos HLA/imunologia , Teste de Histocompatibilidade/métodos , Imunoensaio/métodos , Isoanticorpos/imunologia , Especificidade de Anticorpos , Feminino , Rejeição de Enxerto/etnologia , Humanos , Técnicas de Diluição do Indicador , Masculino , Grupos Minoritários/estatística & dados numéricosRESUMO
We evaluated patient sera for flow PRA, FCXM, and end-point donor-antigen titer, and we correlated the results with graft survival. You cannot accurately predict a positive or negative FCXM result-not even when the sera have donor-specific antigens-unless you actually perform a crossmatch. Using fluorescence intensity as a surrogate for antibody concentration does not correlate quantitatively with the occurrence of a positive or negative crossmatch. Therefore, it is imperative to give each recipient a chance at being offered a donor organ by performance of a real-time crossmatch and not rely on a virtual evaluation.
