CLINICAL AND ECONOMIC-IMPACT OF FLOW-CYTOMETRY CROSS-MATCHING IN PRIMARY CADAVERIC KIDNEY AND SIMULTANEOUS PANCREAS-KIDNEY TRANSPLANT RECIPIENTS

We retrospectively compared the clinical and financial impact of a fin al cross-match by T cell flow cytometry (FXM) versus conventional comp lement-dependent cytotoxicity (CXM) in consecutive primary cadaveric k idney (K) and primary simultaneous cadaveric pancreas-kidney (SPK) tra nsplant recipients. Mean follow-up was 14 months for both the K (range , 5-22 months) and SPK (range, 5-22 months) recipients. There were no instances of a positive CXM result if the FXM result was negative. How ever, 18 of the 102 (18%) K recipients and 11 of the 66 (17%) SPK reci pients were FXM: positive, CXM negative, but no grafts lost to hyperac ute rejection in this group. In addition, patient survival, graft surv ival, incidence of acute rejection, and kidney and pancreas function ( immediate and late) were not different in the FXM-positive versus the FXM-negative groups. Charges for the CXM and FXM methods were compared over a 6-month period. During that period, the FXM charges averaged $ 583 less per recipient than the CXM charges (58% reduction in charges) , and the time required to perform the FXM method was 50% of that requ ired for the CXM method. These results demonstrate that a clinical pat hway for primary transplantation that utilizes the FXM rather than the CXM final cross-match is clinically safe, with no adverse effect on p osttransplant outcome, reduces organ preservation time by shortening t he waiting period for the final cross-match results, and significantly reduces the tissue typing charges. However, about 9% of all primary K and SPK recipients will be FXM positive, CXM negative on final crossm atch and will be unnecessarily denied a transplant. In this study, we describe a method to identify these patients so that they can be teste d by traditional CXM to avoid being denied access to donor organs.