Table 3.
| Transplant immunological data for patients who underwent DSA(+)KPD
| Patient no. | Crossmatch and DSA to intended donora | Crossmatch and DSA to matched DSA(+)KPD donorb | Benefit from DSA(+)KPD matchc | Immunosuppression | Follow-up DSA to matched DSA (+)KPD Donor | Rejection type, time from transplant and DSA present |
|---|---|---|---|---|---|---|
| 1 | T-FXM (17) | T-FXM (8) | B-FXM <200 | IVIG/alemtuzumab | 12 Months: DQ2 (11421) | AMR |
| B-FXM (341) | B-FXM (123) | ↓DSA | FK/MMF/prednisone | A1 (2075) | 17 Days | |
| DR7 (12557), DQ2 (11667) | DQ2 (11667) | All (1739) | 6 Days DQ2 (5982) | |||
| B35 (5693) | 17 Days no serum | |||||
| 40 Days DQ2 (7628) | ||||||
| 2 | ABO-I | T-FXM (42) | ABO-C | IVIG/ATG | No DSA at 6, 12, and 24 months | No rejection |
| T-FXM (419) | B-FXM (60) | T-FXM <50 | ||||
| B-FXM (379) | B-FXM <100 | FK/MMF/prednisone | ||||
| A3 (4512), A33 (7188), DR11 | B71 (2613) | ↓DSA | ||||
| (11993), DR13 (11331), DR52 (13732) | ||||||
| 3 | T-FXM (44) | T-FXM (15) | B-FXM <200 | IVIG/ATG | 6 Months: no DSA | No rejection |
| B-FXM (247) | B-FXM (159) | ↓DSA | 12 Months: DQA 0501 (2200) | |||
| DR51 (8587) | DQA 0501 (3578) | Sirolimus/prednisone | ||||
| 4 | ABO-I | ABO-I | B-FXM <200 | ABO-I protocol/ATG | No DSA at 1 and 2 months | No rejection |
| T-FXM (136) | T-FXM (85) | ↓DSA | ||||
| B-FXM (412) | B-FXM (142) | FK/MMF/prednisone | ||||
| DR14 (11796), DQ5 (9955) DR52 (2279) | A1 (6123), DR52 (2279) | |||||
| 5 | T-FXM (201) | T-FXM (161)d | B-FXM <200 | IVIG/ATG | No DSA at 6,12, and 24 months | No rejection |
| B-FXM (381) | B-FXM (172) | ↓DSA | ||||
| A24 (14575), DR11 (4528) DR 13 (7746), DQ6 (7422) | DQ5 (5452) | FK/MMF/prednisone | ||||
| 6 | ABO-I | ABO-C | ABO-C | IVIG/daclizumab | No DSA at 24 months | No rejection |
| T-FXM (45) | T-FXM (20) | |||||
| B-FXM (36) | B-FXM (77) | ↓↓DSA | FK/MMF/prednisone | |||
| A2 (6328) | A3 (2605) | |||||
| 7 | CDC(+) | CDC(−) | (−)CDC | IVIG/alemtuzumab | 12 Months: DR9 (1308), DR10 (2428), DQ5 (3745) | AMR + ACR |
| T-FXM (226) | T-FXM (69) | B-FXM < 300 | 6 Months | |||
| B-FXM (340) | B-FXM (222) | FK/MMF/prednisone | 18 Months: DR10(2005), DQ5 (2362) | DR9 (8000), DR10 (15000), DQ5 (13000) | ||
| B58 (7793) | ↓DSA | |||||
| DR16 (14341), DQ5 (2688) | B44 (3139), DP17 (2658).DQ5 (2688) | |||||
| 8 | T-FXM (33) | T-FXM (6) | B-FXM <100 | IVIG/ATG | No DSA at 6 and 12 months | No rejection |
| B-FXM (363) | B-FXM (27) | ↓DSA | ||||
| DR4 (15741), DQ7 (3716) | DQ7 (3716), DR9 (3489) | FK/MMF/prednisone | ||||
| 9 | T-FXM (45) | T-FXM (27) | B-FXM <200 | IVIG/ATG | No DSA at 3, 6, and 9 months | AMR |
| B-FXM (327) | B-FXM (170) | ↓DSA | 9 months | 6 DAYS | ||
| DR51 (14397), DR15 (9719) | FK/MMF/prednisone | DR8 (3429), B39 (1132) | ||||
| DR8 (3345) | ||||||
| 10 | ABO-I | ABO-C | ABO-C | IVIG/ATG | 2 Weeks: B44 (8083) | No rejection |
| T-FXM (106) | T-FXM (88) | ↓DSA | 2 Months: B44 (2757) | |||
| B-FXM (115) | B-FXM (107) | FK/MMF/prednisone | 9 Months: B44 (1212) | |||
| B44 (3174), B45 (5335) | B44 (3174) | 12 Months: B44 (1164) | ||||
| 11 | ABO-I | ABO-C | ABO-C | IVIG/ATG | 6 Months: DR17 (1210), DR52 (1447) | No rejection |
| T-FXM (49) | T-FXM (2) | |||||
| B-FXM (79) | B-FXM (102) | FK/MMF/prednisone | 12 Months: DR17 (1300), DR52 (3547) | |||
| DR13 (3478), DR52 (2044) | DR17 (2960), DR52 (2044) | |||||
| 12 | T-FXM (202) | T-FXM (38) | T-FXM < 50 | IVIG/ATG | 3 Months: B52 (2396) | No rejection |
| B-FXM (202) | B-FXM (14) | B-FXM <100 | ||||
| B48 (7359) | B52 (1209) | ↓DSA | FK/MMF/prednisone | 6 Months: B52 (1736) |
Abbreviations: ABO-C, ABO blood group compatible; ABO-I, ABO blood group incompatible; ACR, acute cellular rejection; AMR, antibody-mediated rejection; ATG, antithymocyte globulin; B-FXM, B-cell flow cytometric crossmatch; CDC, complement-dependent cytotoxic crossmatch; DSA, donor-specific antibody; FK, tacrolimus; IVIG, intravenous immune globulin; KPD, kidney paired donation; MFI, median fluorescence intensity; MMF, mycophenolate mofetil; T-FXM, T-cell flow cytometric crossmatch.
↓DSA indicates that donor specific antibodies to the matched KPD donor are fewer in number and/or have lower MFI.
Except where noted, the complement-dependent cytotoxic crossmatch was negative.
(−) CDC indicates that a negative complement-dependent crossmatch was achieved.
MFI for DSA is shown in parentheses following the specific antibody ().
B-FXM and T-FXM values are expressed in median channel shift.
KPD benefit indicates match parameters before administration of IVIG. A T-FXM <50, and B-FXM <100 are considered negative. A B-FXM <200 or <300 denotes that DSA(+)KPD facilitated a positive, but significantly weaker B-FXM than the crossmatch with the original, intended donor.
Patient 5 had a positive auto T-cell flow crossmatch.