Research Article

Three year outcomes following positive cross match renal transplantation despite failure to convert to Negative Flow Cross Match after Desensitization

Shree Patel*, Jamie Benken, Patricia West Thielke, Sanjeev Akkina, Enrico Benedetti and James Thielke

Published: 08/30/2018 | Volume 2 - Issue 2 | Pages: 029-038


Desensitization allows successful transplantation of patients with a positive crossmatch (PXM) against their live donor. We evaluated outcomes following PXM renal transplant despite failure to convert to negative flow cytometric crossmatch (FCXM) after desensitization. Patients that underwent desensitization before PXM transplant between 1/1/00 and 11/1/11 were identified for analysis. Patients who received a transplant despite failure to convert to negative FCXM were identified as the not converted group. Patients who converted to negative FCXM after desensitization comprised the converted group control arm. 108 patients were desensitized before PXM transplant, (not converted group=42; converted group=66). Mean eGFR was comparable between groups at all time points, and 3-year eGFR was 57.8 mL/min vs. 57.1 mL/min, p=0.91. Patients with eGFR < 30mL/min at 3 years did not differ significantly (28% vs. 14%, p=0.15). Biopsy-proven rejection rates were numerically higher within the not converted group for each type of rejection and time point, but the values did not differ significantly. Opportunistic infections rates were comparable. Patient survival (95% vs. 91%) and death-censored allograft survival (84% vs. 95%, p=0.07) were similar between arms at 3 years post-transplant.

Read Full Article HTML DOI: 10.29328/journal.jcn.1001016 Cite this Article


  1. Wolfe  RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting a transplant, and recipients of a first cadaveric transplant. N Engl J Med. 1999; 341: 1725-1730. Ref.:
  2. Annual Report of the U.S. Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients: Transplant Data 1998-2011. Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation, Rockville, MD; United Network for Organ Sharing, Richmond, VA; University Renal Research and Education Association, Ann Arbor, MI. 2011.
  3. Gloor J, Stegall MA. Sensitized renal transplant recipients: current protocols and future directions. Nat Rev Neprol. 2010; 6: 297-306. Ref.:
  4. Claas FH, Doxiadis II. Management of the highly sensitized patient. Curr Opin Immunol. 2009; 21: 569-572. Ref.:
  5. Warren DS, Robert MA. Incompatible kidney transplantation: lessons from a decade of desensitization and paired kidney exchange. Immunol Res. 2010; 47: 257-264. Ref.:
  6. Organ Procurement and Transplant Network Web Site. 2013.
  7. Montgomery RA, Lonze BE, King KE, Edward Kraus S, Lauren Kucirka M, et al. Desensitization in HLA-incompatible kidney recipients and survival. N Engl J Med. 2011; 365: 318-326. Ref.:
  8. West-Thielke P, Herren H, Thielke J, Oberholzer J, Sankary H, et al. Results of positive crossmatch transplantation in African American renal transplant recipients. Am J Transplant. 2008; 8: 348-354. Ref.:
  9. Thielke JJ, West-Thielke PM, Herren HL, Bareato U, Ommert T, et al. Living donor kidney transplantation across positive crossmatch: the University of Illinois at Chicago experience. Transplantation. 2009; 87: 268-273. Ref.:
  10. Jordan SC, Tyan D, Stablein D, McIntosh M, Rose S, et al. Evaluation of intravenous immunoglobulin as an agent to lower allosensitization and improve transplantation in highly sensitized adult patients with end-stage renal disease: Report of the NIH IGO2 trial. J Am Soc Nephrol.2004; 15: 3256-3262. Ref.:
  11. Jordan SC, Vo A, Bunnapradist S, Toyoda M, Peng A, et al. Intravenous immune globulin treatment inhibits crossmatch positivity and allows for successful transplantation of incompatible organs in living donor and cadaver recipients. Transplantation. 2003; 76: 631-636. Ref.:
  12. US Renal Data System, USRDS. Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2011.
  13. Vo AA, Peng A, Toyoda M, Kahwaji J, Cao K, et al. Use of intravenous immune globulin and rituximab for desensitization of highly HLA-sensitized patients awaiting kidney transplantation. Transplantation. 2010; 89: 1095-1102. Ref.:
  14. Stegall MD, Gloor J, Winters JL, Moore SB, Degoey S. A comparison of plasmapheresis versus high-dose IVIG desensitization in renal allograft recipients with high levels of donor specific alloantibody. Am J Transplant. 2006; 6: 346-351. Ref.:
  15. Magee CC, Felgueiras J, Tinckam K, Malek S, Mah H, et al. Renal transplantation in patients with positive lymphocytotoxicity crossmatches: one center's experience. Transplantation. 2008; 86: 96-103. Ref.:
  16. Montgomery RA, Zachary AA. Transplanting patients with a positive donor-specific crossmatch: a single center's perspective. Pediatr Transplant. 2004; 8: 535-542. Ref.:
  17. Truong LD, Barrios R, Adrogue HE, Gaber LW. Acute antibody-mediated rejection of renal transplant: pathogenetic and diagnostic considerations. Arch Pathol Lab Med. 2007; 131:1200-1208. Ref.:
  18. Hirsch HH, Randhawa P. AST Infectious Diseases Community of Practice. BK virus in solid organ transplantation. Am J Transplant. 2009; 9: 136-146. Ref.:
  19. Humar A, Snydman D. AST Infectious Diseases Community of Practice. Cytomegalovirus in solid organ transplant recipients. Am J Transplant. 2009; 9: 78-86. Ref.: