Renal Transplantation with Final Allocation Based on the Virtual Crossmatch.

Solid phase immunoassays (SPI) are now routinely used to detect HLA antibodies. However, the flow cytometric crossmatch (FCXM) remains the established method for assessing final donor-recipient compatibility. Since 2005 we have followed a protocol whereby the final allocation decision for renal transplantation is based on SPI (not the FCXM). Here we report long-term graft outcomes for 508 consecutive kidney transplants using this protocol. All recipients were negative for donor-specific antibody by SPI. Primary outcomes are graft survival and incidence of acute rejection within 1year (AR<1year) for FCXM+ (n=54) and FCXM- (n=454) recipients. Median follow-up is 7.1years. FCXM+ recipients were significantly different from FCXM- recipients for the following risk factors: living donor (24% vs. 39%, p=0.03), duration of dialysis (31.0months vs. 13.5months, p=0.008), retransplants (17% vs. 7.3%, p=0.04), % sensitized (63% vs. 19%, p=0.001), and PRA>80% (20% vs. 4.8%, p=0.001). Despite these differences, 5-year actual graft survival rates are 87% and 84%, respectively. AR<1year occurred in 13% FCXM+ and 12% FCXM- recipients. Crossmatch status was not associated with graft outcomes in any univariate or multivariate model. Renal transplantation can be performed successfully, using SPI as the definitive test for donor-recipient compatibility. The authors examine long-term outcomes for renal transplantation when the kidney allocation is based strictly on a negative virtual crossmatch, as determined by solid phase immunoassays, and independently of the outcome of the flow cytometric crossmatch.