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KMID : 0361120210350040230
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Korean Journal of Transplantation
2021 Volume.35 No. 4 p.230 ~ p.237
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Enhanced virtual crossmatch in intestinal transplantation: association with outcomes and application in practice
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Moon Jang-Il
Ko Huaibin M.
Iyer Kishore R.
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Abstract
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Background: The presence of preformed donor-specific antibodies in recipient serum against anti-human leukocyte antigen is a significant risk factor that negatively affects the outcomes of intestinal transplantation. Avoiding high-risk intestinal transplantation by physical and virtual cross matches has had limited success due to time constraints and ineffective correlation, respectively.
Methods: We developed a guideline to improve the association between physical and virtual cross matches using the retrospective data of 56 consecutive primary adult isolated intestinal transplantations from a single center.
Results: The mean fluorescence intensity of 2,000 for positive donor-specific antibodies revealed the best association between physical and virtual cross matches among different cut-off values, but with an unacceptable false positive rate of 54%. An enhanced virtual cross match with the summation of the mean fluorescence intensity of each anti- human leukocyte antigen improved the association between physical and virtual cross matches, with a sensitivity of 83% and specificity of 98%.
Conclusions: This enhanced virtual cross match more effectively predicts high-risk intestinal transplantation and is a better substitute for physical cross-match than the current virtual cross match. It also helps to avoid ill-considered abandonment of intestinal transplantation that is unnecessarily deemed high risk based on a simple virtual cross match.
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KEYWORD
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Intestinal transplantation, Virtual and physical cross match, Mean fluorescence intensity, Donor specific antibody, Anti-human leukocyte antigen
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