FLOW CYTOMETRY DETECTED IgG IS NOT A CONTRA-INDICATION TO RENAL ALLOTRANSPLANTATION: THE PRESENCE OF IgM MAY BE BENEFICIAL TO OUTCOME RH Kerman, B Susskind, I Buyse, J Ruth, N Sica, S Warnell, A Bayat, M Dang, J Gregory, C Van Buren, S Katz, S

FLOW CYTOMETRY DETECTED IgG IS NOT A CONTRA-INDICATION TO RENAL ALLOTRANSPLANTATION: THE PRESENCE OF IgM MAY BE BENEFICIAL TO OUTCOME
RH Kerman, B Susskind, I Buyse, P. Przyblyowski, J Ruth, S Warnell, A Bayat, M Dang, C Van Buren, S Katz, S. Gruber and BD Kahan Univ of TX Med School - Houston

At our transplant center primary (1° ) recipients (recips) of either a haplo-identical (haplo-ID) living related (LRD) or a cadaveric (CAD) donor renal allograft are transplanted (Tx) following a negative (NEG) donor IgG anti-human globulin (AHG) crossmatch (XM). Testing includes the historically highest panel reactive antibody and the immediate (0-7 days) preTx sera. A positive (POS) donor IgM-AHG XM has not been a contraindication to transplant. Several reports suggest that the donor flow cytometry crossmatch (FCXM) may be more clinically informative than the AHG-XM. We therefore evaluated the impact of a POS FCXM on the rejection frequency (0-12 mos postTx) and one year graft survival for 196 1° -haplo-ID LRD and 136 1° -CAD CsA-Pred treated renal allograft recips. All transplants were performed following a negative donor-specific IgG AHG XM. Rejection frequencies (26% vs 31%, p = NS) and one year graft survivals (92% vs 89%, p = NS) were comparable for haplo-ID LRD FCXM-NEG and IgG POS recips. However, IgM-FCXM POS LRD-recips experienced fewer rejections (13% vs 26%, p<0.02) and an improved one year graft survival (100% vs 92%, p<0.02) than FCXM-NEG LRD recips. Similar results were observed for 1° -CAD recips. Rejection frequencies (40% vs 44%, p=NS) and one year graft survivals (83% vs 81%, p=NS) were comparable for 1° -CAD FCXM-NEG and IgG POS recips. Again, IgM-FCXM POS 1° -CAD recips experienced fewer rejections (22% vs 40%, p<0.02) and improved one year graft survivals (89% vs 83%, p<0.05) than NEG recips. Therefore, a positive IgG FCXM is not a contraindication to transplant and that successful primary LRD and/or CAD renal allotransplantation can be achieved following a NEG IgG-AHG XM. Moreover, the presence of an IgM-POS donor XM donor may be beneficial.