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IDENTIFICATION OF DONOR DIRECTED ANTIBODIES BEFORE AND AFTER TRANNSPLANTATION BY T AND B CELL FLOW CYTOMETRIC CROSSMATCHES

Lenaers, J I.V.; Voorter, C E.M.; Christiaans, M H.L.; van den Berg-Loonen, E M.

Abstracts for Publication Only A1-A326
Free

University Hospital Maastricht, Maastricht, The Netherlands

A3

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Aims:

The presence of donor specific HLA antibodies (DSA) in a patient is a contraindication for kidney-transplantation. Crossmatches (Xm) are performed with the potential donor to exclude the presence of such antibodies.

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Methods:

In 1997 and 1998 124 transplants were performed on 123 patients. According to the local transplant protocol all transplants were performed with a negative CDC-Xm. For 117 patients donor spleen cells were available that were crossmatched retrospectively by flow cytometry (FC). Immunosuppression was tacrolimus based, follow up was till 1/9/03. In the study group a total of 30 grafts failed of which 19 were transplantectomized, and 39 patients experienced at least one rejection episode.

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Results:

T-cell FC-Xm showed 115 patients to be negative and two to have a positive Xm at the time of transplantation. Both transplants failed, one experienced hyperacute rejection and failed after three weeks, the other one failed after two years. T-cell DSA after transplantation were demonstrable in one patient before graft failure and in eight patients after graft failure.

Preliminary results of the B-cell FC-Xm indicate a high percentage of positive crossmatches at the time of transplantation, 9/98 (9%). Also B-cell DSA were detected after transplantation in 20/98 patients (20%). In two patients B-cell DSA were detected before graft failure and in 11 patients after graft failure. Seven patients with B-cell DSA still had a functioning graft.

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Conclusions:

In the present material 2/117 (2%) current T-cell crossmatches and 9/98 (9%) current B-cell crossmatches were positive. From 117 patients nine (8%) produced T-cell DSA at various times after transplantation, most of them after failure. B-cell DSA were also found in 20% of the patients, but with a less deleterious effect on graft outcome sofar.

Identification of HLA antigen specificity is currently under investigation.

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