Kidney and pancreas transplantation without a crossmatch in select circumstances - it can be done

Given the constant flux in caseload and the number of personnel available i n the OR, waiting for a final XM often prolongs organ preservation time (a room available at the time a XM is started is not available when the XM is completed). Longer preservation is associated with increased DGF and decrea sed graft survival. We have shown in a retrospective analysis that final XM s on 0% PRA recipients were always negatitve (Transplantation, 1999). We no w describe a policy of: a) not doing screening XM and b) proceeding to the OR without a XM, in situations where the recipients's PRA has been document ed to be 0% and when there have not been any interim transfusions (and the OR is ready before XM completion). Final XM is completed after the transpla nt. All patients send sera every 6 weeks for PRA (antiglobulin technique). If greater than or equal to3 consecutive PRAs are 0%, no donar-specific scr eening XM is done prior to calling the patient in for tx (UNOS allocation a lgorithm used). If there have not been any interim transfusions, we have pr oceeded to tx prior to completion of the final XM. Between 1 January 1998 a nd 31 December 1999, we did 109 CAD kidney (K) and 79 simultaneous kidney p ancreas (SPK) tx; 67 (61%) K and 56 (71%) SPK had 0% PRA. Of the 0% PRA, 25 /67 (37%) K and 28/56 (50%) SPK had no pretx XM. For K with no XM, cold isc hemia was shorter (13.2 +/- 0.2 vs. 18 +/- 0.9 h, p = 0.01) and DGF less (1 2% vs. 24%, p = 0.3); for SPK with no XM, cold ischemia was shorter (15.2 /- 2 vs. 18 +/- 0.9 h, p = 0.1); no diff in DGF. All post-XM were negative and there were no hyperacute rejections; there was no diff in acute rejecti on episodes. Actuarial I yr graft survival: no XM-K = 87.5%, SKP = 82%; Yes XM-K = 88%, SKP = 86% (NS). Our data suggest it is safe, in select circums tances, to proceed to the OR without a XM. Elimination of the screening XM for 0% PRA candidates saves money. Proceeding to the OR (if available) with out a final XM shortens cold ischemia time.