The influence of crossmatch test sensitivity on outcome in cadaver renal transplantation

Serologic donor-recipient pretransplant crossmatch testing has been a prerequisite for renal transplantation since the early findings of a high correlation between positive donor reactivity and hyperacute rejection. Unfortunately, hyperacute rejection still occurs in about 1% to 2% of all cadaver donor transplants despite a negative crossmatch test, although false-positive corssmatch tests are also known to occur, and presumably contribute to organ wastage. Several studies have examined the relationship of different crossmatch techniques with outcome in terms of analytic sensitivity with variable results. It is well known that the analytic sensitivity of serologic crossmatch assays is highly associated with technique and that standard microlymphocytotoxicity test results can be affected by factors such as incubation time, wash steps, complement source, and use of an antiglobulin reagent. To determine the effect of analytic crossmatch test sensitivity on early graft outcome, we have compared clinical results available from a large, multicenter data base from the South-Eastern Organ Pocurement Foundation (SEOPF) to quality control results of crossmatch testing by SEOPF labs during the same period.