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Kidney Week

Abstract: PO2548

Virtual Reality, a New Vision Becoming Our New Actuality: A Retrospective Study Comparing Virtual Crossmatch vs. Physical Crossmatch at Tampa General Hospital

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Moran, Fernando, Division of Nephrology University of South Florida, Tampa, Florida, United States
  • Chow, Timothy M., Division of Internal Medicine University of South Florida, Tampa, Florida, United States
  • Aldana, Martin, Nephrology and Transplantation University of South Florida, Tampa, Florida, United States
  • Lunz, John, LifeLink Foundation Transplantation Immunology Laboratory, Tampa, Florida, United States
Background

A crossmatch (XM) is required prior to kidney transplantation to ensure immunological compatibility between recipient and donor. This test is prone to false positive reactivity and can increase cold ischemic time (CIT) especially for organs procured outside the region of the transplanting hospital. Advances in HLA antibody testing and donor HLA antigen typing facilitate the use of a virtual XM (VXM) based on pre-transplant testing results to accurately predict a physical XM (PXM) result. Frequent antibody screening and an accurate history of sensitizing events further ensures that the VXM can predict immunological compatibility, even without retrospective PXM.

Methods

We compared the 6 mo. clinical outcomes of kidney recipients who proceeded to transplant with only a VXM (without retrospective PXM) to those receiving a PXM. 182 recipients with 6 mo. follow-up were reviewed for biopsy data, serum Cr and UPCR. Patients were grouped according to the transplant type (living donor (LD) vs. deceased donor (DD)) and XM type (PXM vs. VXM). LD recipients had a PXM (n=42). Patients with a VXM (n=76) were donor-specific antibody (DSA)-free and had a current tested sample within 30 days. DD recipients had PXM (n=64) due to the presence of DSA (current or historic) or the absence of a current tested sample within 30 days. All patients with PXM had an acceptable flow cytometric XM.

Results

Patients proceeding to transplant with a VXM tended to be less sensitized (32% with PRA >0%) compared to DD-PXM (66%) and LD-PXM (49%). For DD recipients, CIT was significantly reduced in patients receiving a VXM (727 vs 871 min; p=0.013). Within the first 6 mo. of follow-up, 67 for cause biopsies were performed. Rejection (T-cell or antibody mediated) was observed in 15 patients (7 DD-VXM, 6 DD-PXM and 3 LD-PXM). Interestingly, antibody mediated rejection was only observed in DD-PXM (n=3) or LD-PXM (n=1) groups.

Conclusion

In our cohort, kidney transplantation with an acceptable VXM was beneficial in reducing CIT and rejection was similar to DD recipients needing a PXM within the first 6 mo. post-transplant. Utilizing VXM helps facilitate kidney transplantation, permits entertaining offers from greater distances, and reduces laboratory burden with similar outcomes to when a PXM is performed.