Detailed study of DSA by molecular technique would prevent wrong exclusion of such donors. False positive report of CDC crossmatch can be caused by the underlying autoimmune diseases such as lupus erythematosus, that may lead to inadvertent refusal of adequate kidney grafts. These implausible results are due to underlying lupus erythematosus, leading to false-positive B-lymphocyte crossmatch as a result of binding immune complexes to Fc-receptors. The positive CDC-crossmatch result is not concordant with DSA status. Luminex-SAB (single antigen bead) did not identify any donor specific antibodies (DSA). His complement dependent cytotoxicity (CDC) crossmatch reported positive for B lymphocyte, but flow cytometry crossmatch (FCXM) was reported negative for both B and T lymphocytes. He is offered a deceased donor kidney with a 1-0-0 mismatch.
The index case is that of a young male with ESRD secondary to Lupus nephritis. Furthermore, each technique is discussed in detail with its pros and cons.
This review aims to provide a worked example using a clinical vignette. Interpretation of crossmatch results can be quite challenging where clinicians have not had formal training in applied transplant immunology. Understanding crossmatch as well as HLA typing for renal transplantation and applying it in clinical practice is the key step to achieve a successful outcome. Contemporary crossmatch methods and human leukocyte antigen (HLA) typing play a pivotal role in improving organ allocation and afford better matches to recipients.
Given the worldwide shortage of organs and growing population of patients with ESRD, those waitlisted for a transplant is ever expanding. Renal transplantation remains the best option for patients suffering from end stage renal disease (ESRD).
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