Nephrology Dialysis Transplantation, Vol 13, Issue 8 2059-2064, Copyright © 1998 by Oxford University Press
M Bittencourt, J Rebibou, Y Saint-Hillier, J Chabod, I Dupont, J Chalopin, P Herve and P Tiberghien
Background. The clinical and immunological relevance
of a positive B-cell flow-cytometry (B-FCXM) crossmatch in renal
transplantation is still controversial. Methods. We
retrospectively analysed 145 consecutive cadaveric renal transplantations
performed from May 1991 to September 1995 in our institution. All grafts
were transplanted following a negative IgG T-cell complement-dependent
cytotoxicity crossmatch (T-CDCXM). Concomitantly to CDCXM, B-cell and
T-cell FCXM were performed and results were expressed as a mean
fluorescence index (FI). Two groups were compared: 116 recipients grafted
with a negative B-FCXM vs a group of 19 patients grafted with a positive
B-FCXM. Results. The two groups were similar for
length of cold ischaemia, donor and recipient's age and degree of HLA
mismatching. The proportion of patients with pre-transplant anti-HLA class
I antibodies or a retransplantation was significantly increased in the
positive B-FCXM group vs the negative B-FCXM group. Recipient survival at
48 months was not significantly different in the two groups. However, graft
survival at 12 and 48 months was significantly poorer in the positive
B-FCXM than in negative B-FCXM (68% vs 90% at 12 months:
P = 0.007, and 57% vs 79% at 48 months:
P = 0.02). Within the positive B-FCXM group, no
differences were found in pre-transplant anti-HLA class I or II
alloimmunization as well as retransplantation frequency between the
patients who lost their graft and the patients who did not.
Conclusion. Our results suggest that a pretransplant
positive B-FCXM is associated with an impaired long-term graft survival in
renal allotransplantation. Keywords: B cell;
flow-cytometry crossmatch; graft survival; renal transplantation
ORIGINAL ARTICLES
Impaired renal graft survival after a positive B-cell flow-cytometry crossmatch
ETS de Franche-Comte, Laboratoire d'Histocompatibilite et Therapeutique Immunomoleculaire, Besancon, France; Service de Nephrologie, CHU Besancon, Besancon, France; Correspondence to: MC Bittencourt, ETS de Franche-Comte, Laboratoire d'Histocompatibilite et Therapeutique Immunomoleculaire, 1 Boulevard Fleming, F-2502 Besancon Cedex, France
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