Korean J Transplant.  2021 Dec;35(4):230-237. 10.4285/kjt.21.0028.

Enhanced virtual crossmatch in intestinal transplantation: association with outcomes and application in practice

• Moon JI
• Ko HM
• Iyer KR

• KMID: 2523672
• DOI: http://doi.org/10.4285/kjt.21.0028

Abstract

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.

Keyword

Intestinal transplantation; Vir tual and physical cross match; Mean fluorescence intensity; Donor specific antibody; Anti-human leukocyte antigen

Figure

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  Fig. 1 Post-hoc correlation between proposed guideline using enhanced virtual cross match (vXM) with summation of the mean fluorescence intensity values of each donor-specific antibody (ƩMFI), physical cross-match (pXM), and outcome of intestinal transplantation (ITX). AR, acute rejection; CDC, complement-dependent cytotoxicity; MFI, mean fluorescence intensity. a)Positive xVM with one donor-specific anti-human leukocyte antigen antibody to DR11 (MFI, 14,382) but resulted negative pXM. No episode of AR with good graft function on 6.6 years follow-up; b)Strong auto-Ab due to Lupus. Negative vXM but resulted positive pXM. Developed mild AR 5 month and severe AR 1.5 year after ITX due to non-compliance.

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