Transplantation with a past positive crossmatch and cyclosporine immunosuppression: A 5‐year experience

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Abstract
Transplantation of the highly sensitized patient continues to be a major problem. Since 1981, patients with a positive crossmatch using historical sera, but negative using current sera, have been accepted for transplantation. Initially, serum samples were required to be negative for 18 months preceding transplantation; this period has been reduced to 6 months. All patients received pretransplant transfusions; kidneys were transplanted to the ABO‐compatible recipient who was longest on the waiting list. Between January 1983 and January 1988, 230 adult recipients underwent cadaver transplantation and were immunosuppressed with prednisone and cyclosporine. Outcome was compared between those with (n = 64) and those without (n = 166) past positive crossmatches. There was no difference in HLA or DR matching. Patients with past positive crossmatches had significantly higher (p < .05) peak and current PRA. There was no difference in actuarial patient or graft survival for those with and without past positive crossmatches for both first transplants (past pos n = 47; all neg n = 149) and retransplants (past pos n = 17; all neg n = 17). Similarly, there was no difference in need for dialysis in the 1st week, graft loss in the 1st month, or mean current creatinine level. Interestingly, first transplant recipients without past positives had a higher incidence of rejection in the first 2 wk (p < .05). We conclude that renal transplantation with a past positive but current negative crossmatch is compatible with good patient and graft survival.