pISSN 2671-8790 eISSN 2671-8804

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Korean J Transplant 2021; 35(4): 230-237

Published online December 31, 2021

https://doi.org/10.4285/kjt.21.0028

© The Korean Society for Transplantation

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

Jang Il Moon1 , Huaibin M Ko2 , Kishore R Iyer1

1Recanati Miller Transplantation Institute and Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
2Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

Correspondence to: Jang Il Moon
Recanati Miller Transplantation Institute and Department of Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1104, New York, NY 10029, USA
Tel: +1-212-659-9300
Fax: +1-212-241-2064
E-mail: jang.moon@mountsinai.org

Received: October 18, 2021; Revised: November 19, 2021; Accepted: December 6, 2021

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

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

HIGHLIGHTS
  • Positive physical cross match results in poor outcome after intestinal transplantation.

  • There is a significant discrepancy between physical and virtual cross match result.

  • Current virtual cross match needs to be enhanced to match physical cross match.