CAN WE TRANSPLANT WITH A POSITIVE CROSS-M ATCH

Differential cross-matches have been proposed to allow immunised patie nts to be grafted, whereas the dogma of a global positive cross-match discarded them from renal transplantation. We report our one-center ex perience considering current T positive cross-match as the only contra -indication to grafting, as well as patients whose sera comprise speci fic anti-donnor antibodies. A comprehensive characterization of the an tibodies was achieved by identification of auto-antibodies and specifi cation of IgM and IgG isotype, class I and class II specificities, as well as HLA specificities. The differential cross-match comprised an a uto and an allo-cross-match, against T and B lymphocytes. Historical a nd current sera were analysed either untreated or after DTT;treatment, at + 4 degrees C and + 22 degrees C. We performed 79 renal transplant ations across positive crossmatches, which were 20 historical T positi ve cross-matches, 26 historical B positive cross-matches and 33 curren t B positive cross-matches. Results and graft survival were strictly i dentical as those obtained in the transplantations achieved with negat ive cross-matches throughout the same period, especially in sensitized patients. Current positive B cell cross-matches due to IgG were assoc iated with an increased risk for early graft failure. We conclude that differential cross-match is a safe strategy permitting immunised pati ents to be grafted.