Long-term graft survival is improved in cadaveric renal retransplantation by flow cytometric crossmatching

Background. Cadaveric renal retransplantation is associated with a higher r isk of early graft failure than primary grafts. A large proportion of those graft losses is likely attributable to donor-directed HLA class I antibodi es, detectable by flow cytometry crossmatching but not by conventional cros smatching techniques. Methods. Long-term graft survival in a group of 106 recipients of consecuti ve cadaveric renal regrafts between 1990 and 1997, in whom a negative flow T-cell IgG; crossmatch was required for transplantation, was compared with two other groups of cadaveric transplant recipients. The first group consis ted of 174 cadaveric regrafts transplanted between 1985 and 1995 using only a negative anti-human globulin (AHG) T-cell IgG crossmatch. The second gro up was primary cadaveric transplants done concurrently with the flow group (1990 to 1997) using only the AHG T-cell IBG; crossmatch. Results. The long-term (7 year) graft survival rate of flow crossmatch-sele cted regraft recipients (68%; n=106) was significantly improved over that o f regraft recipients who were selected for transplantation by only the AHG crossmatch technique (45%; n=174; log-rank=0.001; censored for patients dyi ng with a functioning graft). Graft outcome for the flow crossmatched regra ft recipients was not significantly different from that of primary cadaveri c patients (72%; n=889; log-rank=0.2; censored for patients dying with a fu nctioning graft). Finally, a positive B-cell IgG flow cytometric crossmatch had no influence on long-term regraft outcome. Conclusions. The use of the flow T-cell IgG; crossmatch as the exclusion cr iterion for cadaveric renal retransplantation yields an improved long-term graft outcome over that obtained when only the AHG crossmatch is used and h as improved survival of regraft recipients to the level of our primary cada veric renal transplant population.