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

Jang Il Moon, Huaibin M. Ko, Kishore R. Iyer

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)230-237
Number of pages8
JournalKorean Journal of Transplantation
Volume35
Issue number4
DOIs
StatePublished - Dec 2021

Keywords

  • Anti-human leukocyte antigen
  • Donor specific antibody
  • Intestinal transplantation
  • Mean fluorescence intensity
  • Virtual and physical cross match

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