An approach to reducing early kidney transplant failure by flow cytometry crossmatching

Abstract

A relationship between kidney transplants that did not function during the 1st month posttranpslant, and a positive T‐cell flow cytometry crossmatch (FCXM), was observed in a retrospective study of 231 cadaver donor transplants. Overall, FCXM‐positive grafts (23%) had a 33% 1‐month nonfunction rate compared to 8% if the FCXM was negative (p = 0.00004). If only sensitized patients had been studied (regrafts and peak antibody‐positive patients), 16 of 17 (94%) of the FCXM‐associated nonfunctional grafts would have been identified. No association between the FCXM and early transplant outcome was seen with nonsensitized patients (63% of the total). Had the FCXM been utilized prospectively in this series, one‐half (16 of 32) of the grafts that did not function would not have been performed. We provide here a practical protocol by which the FCXM can be used on a routine basis.