Abstract
There is no doubt that the interpretation of a positive lymphocytotoxic crossmatch test has changed over the past 10–15 years. It is now generally accepted that the original dogma put forward in the mid-1960s “that a renal transplant must not be performed in the presence of a positive lymphocytotoxic crossmatch” is no longer tenable, and many positive crossmatch transplants have already been successfully carried out. However, the precise conditions under which such a transplant can be performed are still not fully understood. Some factors which should be considered when deciding whether or not to transplant in the presence of a positive crossmatch are: (1) the specificity of the antibody, and this can be HLA class I, class II or non-HLA; (2) the time interval between the last positive crossmatch serum and transplantation; and (3) the immunoglobulin class of the antibody, either IgG or IgM.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ahern AT, Artruc SB, Della Pelle P, Cosimi AB, Russell PS, Colvin RB, Fuller TC (1982) Hyperacute rejection of HLA-AB-identical renal allografts associated with B lymphocyte and endothelial reactive antibodies. Transplantation 33: 103–106
Ayoub GM, Terasaki PI, Tonai RJ (1983) Improvements in detection of sensitization. Transplant Proc 15: 1202–1207
Cardella CJ, Falk JA, Nicholson MJ, Harding M, Cook GT (1982) Successful renal transplantation in patients with T-cell reactivity to donor. Lancet II: 1240–1243
Chapman JR, Taylor CJ, Ting A, Morris PJ (1986) Immunoglobulin class and specificity of antibodies causing positive T cell crossmatches. Relationship to renal transplant outcome. Transplantation 42: 608–613
Cross DE, Greiner R, Whittier FC (1976) Importance of the autocontrol crossmatch in human renal transplantation. Transplantation 21: 307–311
Dejelo CL, Williams TC (1977) B-cell cross-match in renal transplantation. Lancet II: 241
Ettenger RB, Terasaki PI, Opelz G, Malekzadeh M, Pennisi AJ, Uittenbogaart C, Fine R (1976) Successful renal allografts across a positive cross-match for donor B-lymphocyte alloantigens. Lancet II: 56–58
Ettenger RB, Uittenbogaart C, Pennisi AJ, Malekzadeh MH, Fine RN (1979) Long-term cadaver allograft survival in the recipient with a positive B lymphocyte crossmatch. Transplantation 27: 315–318
Ettenger RB, Jordan SC, Fine RN (1983) Cadaver renal transplant outcome in recipients with autolymphocytotoxic antibodies. Transplantation 35: 429–431
Fuller TC, Forbes JB, Delmonico FL (1985) Renal transplantation with a positive historical donor crossmatch. Transplant Proc 17: 113–114
Goeken NE (1985) Outcome of renal transplantation following a positive crossmatch with historical sera: The second analysis of the ASHI survey. Transplant Proc 17: 2443–2445
Jeannet M, Stalder H (1978) Lymphocytotoxic antibodies in spontaneous cytomegalovirus infection. Lancet I: 509
Jeannet M, Benzonana G, Arni I (1981) Donor-specific B and T lymphocyte antibodies and kidney graft survival. Transplantation 31: 160–163
Lobo PI, Westervelt FB, Rudolf LE (1977) Kidney transplantability across a positive cross-match. Cross-match assays and distribution of B lymphocytes in donor tissues. Lancet I: 925–928
Mohanakumar T, Rhodes C, Mendez-Picon G, Goldman M, Moncure C, Lee H (1981) Renal allograft rejection associated with presensitization to HLA-DR antigens. Transplantation 31: 93–95
Palmer A, Taube D, Welsh K, Brynger H, Delin K, Gjörstrup P, Konar J, Söderström T (1987) Extracorporeal immunoadsorption of anti-HLA antibodies: Preliminary clinical experience. Transplant Proc 19: 3750–3751
Patel R, Terasaki PI (1969) Significance of the positive crossmatch test in kidney transplantation. N Engl J Med 280: 735–739
Pellegrino MA, Belvedere M, Pellegrino AG, Ferrone S (1978) B peripheral lymphocytes express more HLA antigens than T peripheral lymphocytes. Transplantation 25: 93–95
Peto R, Pike MC, Armitage P, Breslow NE, Cox DR, Howard SV, Mantel N, McPherson K, Peto J, Smith PG (1977) Design and analysis of randomized clinical trials requiring prolonged observation of each patient. II. Analysis and examples. Br J Cancer 35: 1–39
Reekers P, Lucassen-Hermans R, Koene RAP, Kunst VAJM (1977) Autolymphocytotoxic antibodies and kidney transplantation. Lancet 1: 1063–1064
Schweizer RT, Bow LM (1983) Successful kidney transplantation after loss of specific antidonor HLA antibodies. Transplantation 36: 731–733
Stocker JW, McKenzie IFC, Morris PJ (1969) IgM activity in human lymphocytotoxic sera after renal transplantation. Nature 222: 483–484
Taylor CJ, Chapman JR, Fuggle SV, Ting A, Morris PJ (1987) A positive B cell crossmatch due to IgG anti-HLA-DQ antibody present at the time of transplantation in a successful renal allograft. Tissue Antigens 30: 104–112
Terasaki PI, Thrasher DL, Hauber TH (1968) Serotyping for homotransplantation. XIII. Immediate kidney rejection and associated preformed antibodies. In: Dausset J, Hamburger J, Mathe G (eds) Advance in transplantation. Copenhagen, Munksgaard, 225–229
Ting A, Morris PJ (1978) Reactivity of autolymphocytotoxic antibodies from dialysis patients with lymphocytes from chronic lymphocytic leukemia (CLL) patients. Transplantation 25: 31–33
Ting A, Morris PJ (1983) Successful transplantation with a positive T and B cell crossmatch due to autoreactive antibodies. Tissue Antigens 21: 219–226
Tongio MM, Mayer S (1985) Naturally occurring HLA antibodies. Transplant Clin Immunol 17: 45–56
Williams GM, Hume DM, Hudson RP, Morris PJ, Kano K, Milgrom F (1968) “Hyperacute” renal-homograft rejection in man. N Engl J Med 279: 611–618
Author information
Authors and Affiliations
About this article
Cite this article
Ting, A. Positive crossmatches — when is it safe to transplant?. Transplant Int 2, 2–7 (1989). https://doi.org/10.1007/BF02425963
Issue Date:
DOI: https://doi.org/10.1007/BF02425963