LABORATORY IMMUNOLOGY - IMMUNE MONITORING AND MOLECULAR DIAGNOSIS

L.T.S. Saber¹, M.A. Giavanetti¹, T.S. Lima¹, L.M. Lima¹, C. Silveira¹, T.M.P. Garcia¹, A.P. Lucera², E.A. Donadi^3
1Transplant Renal Unit, Clical Hospital of Faculty of Medicine of Ribeirão Preto - University of São Paulo, Ribeirão Preto/BRAZIL, ²Hla Laboratory-department Of Clinical Immunology, Clical Hospital of Faculty of Medicine, Ribeirão Preto/BRAZIL, ³Department Of Clinical Immunology, School of Medicine of Ribeirão Preto - USP, Ribeirão Preto/BRAZIL

Body: Introduction: Since 1997, the Brazilian State of São Paulo has adopted an organ allocation program, based on the criteria proposed by the United Network for Organ Sharing (UNOS). In this system, the State is divided in two regional allocation lists, but with no boundaries within the State for a zero mismatch (0MM) recipient. Case Report and Discussion: We report a case of a 35 year old male patient that was submitted to a deceased donor kidney transplant on September 9^th, 2009. Patient presented end stage renal disease of unknown origin on haemodyalisis for five years; had two previous blood transfusions (last one in 2005), panel reactive antibody activity (PRA) of zero (last serum from May 21^st 2009) for class I, class II and MIC antigens; blood type AB positive, HLA A2,24 B50,51 DR4,13. Kidney donor: Male, 41 years old, 80kg, death due to stroke, blood type A positive, creatinine at admission 1,2mg% and 2,6mg% at donation. Co-morbidities: arterial hypertension and alcoholism. HLA A2,24 B50, __ DR 4,13. The kidney was allocated on a zero mismatch basis. Conventional complement-dependent cytotoxicity crossmatch (CXM) was negative to T and B lymphocytes. Cold ischemia time was 20hs. Initial immunosuppression consisted of Basiliximab, Tacrolimus, Mycophenolate Sodium and Methylprednisolone. The kidney presented initial good perfusion but 10 minutes later, presented hyperacute humoral rejection leading to nephrectomy, which was confirmed by the anatomo-pathological study. The CXM was repeated with the same previous results. We had no more donor cells to perform FCXM. In this specific case one can not say if FXCM would be positive and we question ourselves if this patient would even be eligible for FCXM prior to transplant: male, first transplant, PRA zero, 0MM, blood type AB positive. In this study we discuss the economical impact, advantages and disadvantages as well the feasibility of performing FCXM for all patients, as for in literature, about 1-2% of the CXM may be false negative but on the other hand, as much as 9% of all primary kidney recipients will be FCXM positive, CXM negative on final crossmatch and will be unnecessarily denied a transplant.

Disclosure: All authors have declared no conflicts of interest.