Fig. 2.

Relationship among donor-specific antibody (DSA), flow cytometry cross match (FCMX) results and risk for antibody-mediated rejection (AMR) in patients desensitized with intravenously administered immunoglobulin (IVIG) + rituximab. We show that reduction, but not elimination, of DSA to levels of ~100,000 standard fluorescent intensity (SFI) correlates with a FCMX of ~200–225 mean channel shifts (MCS). This usually allows transplantation of highly human leukocyte antigen (HLA)-sensitized patients with a low risk of AMR. However, patients who demonstrate DSA 100,000–200,000 SFI and FCMX >250 channel shifts (CS) are more likely to experience AMR. Patients who demonstrate complement-dependent cytotoxicity (CDC+) cross matches have FCMXs >300 MCS and DSA levels >200,000. These patients are at an extremely high risk for AMR if transplanted. The line shows the hypothetical relationship between DSA and FCMX results. A normal FCMX is defined as 50 CS or less and an SFI DSA level of 10,000 or less