Analysis of positive kidney, heart, and liver transplant crossmatches reported to the Collaborative Transplant Study

The relationship of positive lymphocytotoxic T-cell and B-cell crossmatches as well as that of flow-cytometric crossmatches with transplant survival was analyzed in kidney, heart, and liver transplants from deceased donors reported to the international Collaborative Transplant Study. High rates of hyperacute rejection were not observed with any type of crossmatch test or type of organ transplant, probably because immunosuppressive treatment has improved. Positive lymphocytotoxic T-cell crossmatches were associated with significantly decreased graft survival in first kidney transplants performed from 1990 to 1999, but not from 2000 to 2007, in kidney retransplants regardless of transplant period and in heart and liver transplants. Positive B-cell crossmatches were associated with significantly decreased kidney and heart transplant survival. It is concluded that a positive lymphocytotoxic crossmatch continues to indicate an increased risk of graft loss and that pretransplantation crossmatches should be performed regardless of type of organ transplanted.