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Presenter: Anil, Vaidya, Oxford, United Kingdom
Authors: Suzanne Page2, Sue Fuggle2, Anil Vaidya1, Peter Friend1
Suzanne Page2, Sue Fuggle2, Anil Vaidya1, Peter Friend1
1Department of Transplant surgery, Oxford Transplant Center, Oxford, United Kingdom; 2Department of Immunology, Oxford Transplant Center, Oxford, United Kingdom
Introduction: The consensus on transplanting against a positive cross match in a modified multivisceral or isolated intestinal graft recipient is still divided. In the interim, being a newly designated center, we err on the cautious side and do not transplant across a positive cross match. We analysed our data on the HLA-profiles of our patients on the waiting list using different parameters including the amount of C1-q fixing antibodies.
Patients and Materials: Waiting list patients were monitored regularly by solid phase assay using HLA single antigen beads. Calculated reaction frequencies (cRF) and median fluorescence intensity (MFI) were recorded. Furthermore cRF's were calculated for antibodies with an MFI of greater than 5000. In addition, C1q-fixing HLA antibodies were studied.
Results: From January 2009 to date, 5 patients were studied. Calculated reaction frequencies ranged from 99%-100%. cRF's for antibodies greater than 5000 (listed as unacceptable) was no different and these patients still remained highly sensitised with a cRF > 85%. However, cRF's calculated after eliminating complement fixing antibodies (by the C1q assay) significantly improved the cRF's in these patients. The range of cRF was reduced, ranging from 74%-0%. Interestingly all patients were negative for C1q-fixing Class II HLA antibodies. To determine how this change in cRf would benefit our patients all potential donor offers received between March 2011 and May 2011 were reviewed. The mean percentage of potential donors versus suitable donors improved significantly by 56% (range 22%-100%).
Conclusion: Access to a negative cross match transplant was significantly improved if only C1q-fixing antibodies were deemed as unacceptable. Incidentally, two patients from the list got offered a suitable matched organ. One patient got transplanted with a negative cross match and the other was not suitable due to non immunological reasons. Waiting for a negative cross match may be detrimental to the progression of the patients condition and therefore the importance of non-complement fixing donor specific antibodies should not be dismissed even though their relevance is unclear.
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