Selective omission of the donor cross-match before renal, transplantation - Efficacy, safety and effects on cold storage time

Background. A donor lymphocyte cross-match (XM) test performed before renal transplantation is considered mandatory but may delay the transplant and i ncrease the cold storage time. With careful documentation of sensitizing ev ents and with knowledge of previous antibody screening results, it is often possible to predict the XM result for a given donor HLA mismatch. In this study, a policy was adopted of omitting the pretransplant XM in patients in whom a negative result was predicted with absolute confidence. Methods. Recipients were selected for cadaveric donor kidney transplantatio n using a computer algorithm based on HLA match, sensitization status, time on the waiting list and donor and recipient age. The immediate pretranspla nt cross-match test was omitted in non-sensitized recipients and in sensiti zed recipients where antibody specificities were precisely defined and not against donor HLA. Results. From October 1997 to May 1999, 53 of 96 (55%) consecutive cadaveri c kidney donor transplants were performed without a pretransplant XM. In al l cases, a negative donor HLA-specific antibody XM was confirmed after tran splantation. Omission of the pretransplant XM was associated with a signifi cant reduction in cold ischemic time (15.0 hr vs. 18.2 hr, P=0.01) and a re duced incidence of delayed graft function (13% vs. 33%, P=0.03), However, t here was no difference in transplant outcome at 1 year. Conclusion. Rigorous attention to priming events together with careful anti body screening allows the pretransplant XM test to be safely omitted in app roximately half the patients awaiting renal transplantation. This policy al lows a modest reduction in cold ischemia time, but it remains to be seen wh ether this is of clinical benefit.