THE SIGNIFICANCE OF A POSITIVE FLOW-CYTOMETRY CROSS-MATCH TEST IN PRIMARY KIDNEY-TRANSPLANTATION

This study was conducted to determine the efficacy of the T cell flow cytometry crossmatch (T-FCXM) test in 841 first cadaver donor transpla nts. Results showed one-year graft survival rates were 82% for T-FCXM- negative patients, compared with 75% for T-FCXM-positive patients (P = 0.01). Early one-month graft failure was 13 percentage points higher in those with a positive T-FCXM than those with a negative T-FCXM. The positive crossmatch patients also had more frequent immunological fai lures. A positive T-FCXM was found in 39% of the sensitized patients ( PRA > 10%) and 8% of those who had not been sensitized. Patients with a positive T-FCXM in either category had a 74% graft survival rate. Th us, most of the T-FCXM-positive results occurred in patients with comp lement-fixing antibodies. It is suggested that flow cytometry crossmat ching (FCXM) be used prospectively, despite the fact that many patient s with a positive crossmatch did have successful transplants (TXs). In the current climate of a cadaver kidney scarcity and large recipient waiting pools, utilization of kidneys for patients with the highest pr obability of success seems a most prudent policy.