Immunogenetic characterization of the transplant recipient with crossmatch is used to minimize graft loss by\r\ndetecting preformed antibodies. Use of increasingly sensitive tests including flow cytometry crossmatch (FCXM) has\r\nbeen accompanied by near elimination of hyperacute rejection. We reviewed associations of crossmatch results with\r\nkidney graft outcomes in contemporary practice, and provided updates of our past publications with more recent\r\ndata in several instances. Recent United States registry data for transplants performed with a reported positive\r\ncrossmatch demonstrate immediate graft loss rates of =1.3% in FCXM+ recipients, and =3.6% in complementdependent\r\ncytotoxicity crossmatch positive (CDCXM+) recipients. One-year graft survival was reduced by =6.4% in\r\nFCXM+ versus FCXMââ?¬â?? recipients, and by =11.5% in CDCXM+ versus CDCXMââ?¬â?? recipients. Five-year graft survival\r\nwas reduced by =10.2 % in FCXM+ versus FCXMââ?¬â?? recipients, and by =8.7% in CDCXM+ versus CDCXMââ?¬â?? recipients.\r\nA possible explanation for the markedly lower graft loss risk with crossmatch positive transplants in modern practice\r\nmay be selection of recipients with low anti-HLA titers. Although a good correlation between virtual crossmatch and\r\nactual crossmatch has been demonstrated, the outcome significance of positive virtual/negative actual and negative\r\nvirtual/positive actual crossmatches is not clearly established. Post-transplant demonstration of the persistence or\r\nappearance of donor-specific antibody is of value in prognostication, but utility for adjustment of therapy is uncertain.\r\nIn summary, contemporary data suggest that, among selected transplants performed, the impact of a positive\r\ncrossmatch may be relatively small compared to other accepted clinical factors. Further study is warranted work to\r\ndetermine, prospectively, under what circumstances crossmatch positive transplants can precede with safety.
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