Improved Graft Survival in Cadaveric Renal Retransplantation by Flow Crossmatching

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Abstract
Objective: To evaluate the role of flow cytometry crossmatching on graft survival in patients undergoing cadaveric renal retransplantation compared with our conventional antihuman globulin cytotoxic crossmatch. Design: In 1990, 6 of 7 transplantation centers in 1 organ procurement organization service area began performing cadaveric renal retransplantation only if the flow T-cell IgG crossmatch was negative. During that period, 1 center continued to use only the antihuman globulin T-cell IgG crossmatch. Prior to 1990, all centers used only the antihuman globulin T-cell IgG crossmatch as their crossmatch selection criterion for retransplantation. Regraft survival was compared between those centers by crossmatch selection criteria. Patients: Patient selection and immunosuppression decisions were made at the transplantation center. Setting: All flow cytometry crossmatches for all 7 centers participating in the evaluation were performed at the Histocompatibility Laboratory of the Midwest Organ Bank Inc, Westwood, Kan. Results: Graft survival is significantly better (P=.03 [logrank test]) in regrafts when the flow crossmatch is used to select patients for transplantation. Conclusion: Flow crossmatching improves graft survival in cadaveric renal retransplantation by identifying a subset of patients with donor-directed HLA class I antibodies that are not detectable by our conventional antihuman globulin crossmatch. (Arch Surg. 1996;131:599-603)