FLOW-CYTOMETRY CROSS-MATCH - A METHOD FOR PREDICTING GRAFT-REJECTION

Long-term graft survival is mainly influenced by early graft rejection and posttransplant graft function, The ability of both complement-dep endent cytotoxicity cross-match (CDC) and flow cytometry crossmatch (F CXM) to predict acute rejection episodes has been evaluated by cross-m atching 40 patients who received cadaveric kidney transplants, before (current serum) and after transplantation (on days 1, 7, 14, 21, 28, 6 0, and 90). Of the 40 patients, all of whom had a negative CDC before transplant, seven patients had a positive FCXM before transplant: five of them (5/7=71.4%) experienced severe rejection within 2 months afte r transplantation, In patients with a negative FCXM before transplant, the incidence of acute rejection was lower (25.8%), Pre-transplant FC XM recipients who had a positive FCXM after transplant, experienced mo re frequent rejection (38.5%) than those pre-transplant FCXM recipient s who never had a positive FCXM (15.8%). With respect to the incidence of acute graft rejection, no difference was found between patients wh o had a positive CDC after transplant and those who had a negative CDC after transplant. Patients who had a positive FCXM before transplant had significantly higher creatinine levels within the first month afte r transplant, Immediate onset of function and accelerated lowering of the creatinine level were found to be more frequent in patients who ha d a negative FCXM before transplant. As early graft rejection is the l argest contributing factor for the development of chronic rejection an d, therefore, of graft loss, we regard FCXM as a sensitive method for predicting long-term prognosis and graft survival, due to its competen ce in predicting both restricted graft function and early acute reject ion, in particular.