Kidney and pancreas transplantation without a crossmatch in select circumstances - It can be done

Arthur J. Matas, Abhinav Humar, Raja Kandaswamy, William D. Payne, Rainer W G Gruessner, David E R Sutherland

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Given the constant flux in caseload and the number of personnel available in the OR, waiting for a final XM often prolongs organ preservation time (a room available at the time a XM is started is not available when the XM is completed). Longer preservation is associated with increased DGF and decreased graft survival. We have shown in a retrospective analysis that final XMs on 0% PRA recipients were always negative (Transplantation, 1999). We now describe a policy of: a) not doing screening XM and b) proceeding to the OR without a XM, in situations where the recipients's PRA has been documented to be 0% and when there have not been any interim transfusions (and the OR is ready before XM completion). Final XM is completed after the transplant. All patients send sera every 6 weeks for PRA (antiglobulin technique). If ≥3 consecutive PRAs are 0%, no donar-specific screening XM is done prior to calling the patient in for tx (UNOS allocation algorithm used). If there have not been any interim transfusions, we have proceeded to tx prior to completion of the final XM. Between 1 January 1998 and 31 December 1999, we did 109 CAD kidney (K) and 79 simultaneous kidney pancreas (SPK) tx; 67 (61%) K and 56 (71%) SPK had 0% PRA. Of the 0% PRA, 25/67 (37%) K and 28/56 (50%) SPK had no pretx XM. For K with no XM, cold ischemia was shorter (13.2±0.2 vs. 18±0.9 h, p=0.01) and DGF less (12% vs. 24%, p=0.3); for SPK with no XM, cold ischemia was shorter (15.2±2 vs. 18±0.9 h, p=0.1); no diff in DGF. All post-XM were negative and there were no hyperacute rejections; there was no diff in acute rejection episodes. Actuarial 1 yr graft survival: no XM-K=87.5%, SKP=82%; Yes XM-K=88%, SKP=86% (NS). Our data suggest it is safe, in select circumstances, to proceed to the OR without a XM. Elimination of the screening XM for 0% PRA candidates saves money. Proceeding to the OR (if available) without a final XM shortens cold ischemia time.

Original languageEnglish (US)
Pages (from-to)236-239
Number of pages4
JournalClinical Transplantation
Volume15
Issue number4
DOIs
StatePublished - 2001
Externally publishedYes

Fingerprint

Cold Ischemia
Pancreas Transplantation
Kidney Transplantation
Graft Survival
Organ Preservation
Kidney
Pancreas
Anti-Idiotypic Antibodies
Transplantation
Transplants
Serum

Keywords

  • Crossmatch
  • Kidney
  • Transplantation

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Kidney and pancreas transplantation without a crossmatch in select circumstances - It can be done. / Matas, Arthur J.; Humar, Abhinav; Kandaswamy, Raja; Payne, William D.; Gruessner, Rainer W G; Sutherland, David E R.

In: Clinical Transplantation, Vol. 15, No. 4, 2001, p. 236-239.

Research output: Contribution to journalArticle

Matas, Arthur J. ; Humar, Abhinav ; Kandaswamy, Raja ; Payne, William D. ; Gruessner, Rainer W G ; Sutherland, David E R. / Kidney and pancreas transplantation without a crossmatch in select circumstances - It can be done. In: Clinical Transplantation. 2001 ; Vol. 15, No. 4. pp. 236-239.
@article{268fc52d2214454bb95122e272dcf193,
title = "Kidney and pancreas transplantation without a crossmatch in select circumstances - It can be done",
abstract = "Given the constant flux in caseload and the number of personnel available in the OR, waiting for a final XM often prolongs organ preservation time (a room available at the time a XM is started is not available when the XM is completed). Longer preservation is associated with increased DGF and decreased graft survival. We have shown in a retrospective analysis that final XMs on 0{\%} PRA recipients were always negative (Transplantation, 1999). We now describe a policy of: a) not doing screening XM and b) proceeding to the OR without a XM, in situations where the recipients's PRA has been documented to be 0{\%} and when there have not been any interim transfusions (and the OR is ready before XM completion). Final XM is completed after the transplant. All patients send sera every 6 weeks for PRA (antiglobulin technique). If ≥3 consecutive PRAs are 0{\%}, no donar-specific screening XM is done prior to calling the patient in for tx (UNOS allocation algorithm used). If there have not been any interim transfusions, we have proceeded to tx prior to completion of the final XM. Between 1 January 1998 and 31 December 1999, we did 109 CAD kidney (K) and 79 simultaneous kidney pancreas (SPK) tx; 67 (61{\%}) K and 56 (71{\%}) SPK had 0{\%} PRA. Of the 0{\%} PRA, 25/67 (37{\%}) K and 28/56 (50{\%}) SPK had no pretx XM. For K with no XM, cold ischemia was shorter (13.2±0.2 vs. 18±0.9 h, p=0.01) and DGF less (12{\%} vs. 24{\%}, p=0.3); for SPK with no XM, cold ischemia was shorter (15.2±2 vs. 18±0.9 h, p=0.1); no diff in DGF. All post-XM were negative and there were no hyperacute rejections; there was no diff in acute rejection episodes. Actuarial 1 yr graft survival: no XM-K=87.5{\%}, SKP=82{\%}; Yes XM-K=88{\%}, SKP=86{\%} (NS). Our data suggest it is safe, in select circumstances, to proceed to the OR without a XM. Elimination of the screening XM for 0{\%} PRA candidates saves money. Proceeding to the OR (if available) without a final XM shortens cold ischemia time.",
keywords = "Crossmatch, Kidney, Transplantation",
author = "Matas, {Arthur J.} and Abhinav Humar and Raja Kandaswamy and Payne, {William D.} and Gruessner, {Rainer W G} and Sutherland, {David E R}",
year = "2001",
doi = "10.1034/j.1399-0012.2001.150403.x",
language = "English (US)",
volume = "15",
pages = "236--239",
journal = "Clinical Transplantation",
issn = "0902-0063",
publisher = "Wiley-Blackwell",
number = "4",

}

TY - JOUR

T1 - Kidney and pancreas transplantation without a crossmatch in select circumstances - It can be done

AU - Matas, Arthur J.

AU - Humar, Abhinav

AU - Kandaswamy, Raja

AU - Payne, William D.

AU - Gruessner, Rainer W G

AU - Sutherland, David E R

PY - 2001

Y1 - 2001

N2 - Given the constant flux in caseload and the number of personnel available in the OR, waiting for a final XM often prolongs organ preservation time (a room available at the time a XM is started is not available when the XM is completed). Longer preservation is associated with increased DGF and decreased graft survival. We have shown in a retrospective analysis that final XMs on 0% PRA recipients were always negative (Transplantation, 1999). We now describe a policy of: a) not doing screening XM and b) proceeding to the OR without a XM, in situations where the recipients's PRA has been documented to be 0% and when there have not been any interim transfusions (and the OR is ready before XM completion). Final XM is completed after the transplant. All patients send sera every 6 weeks for PRA (antiglobulin technique). If ≥3 consecutive PRAs are 0%, no donar-specific screening XM is done prior to calling the patient in for tx (UNOS allocation algorithm used). If there have not been any interim transfusions, we have proceeded to tx prior to completion of the final XM. Between 1 January 1998 and 31 December 1999, we did 109 CAD kidney (K) and 79 simultaneous kidney pancreas (SPK) tx; 67 (61%) K and 56 (71%) SPK had 0% PRA. Of the 0% PRA, 25/67 (37%) K and 28/56 (50%) SPK had no pretx XM. For K with no XM, cold ischemia was shorter (13.2±0.2 vs. 18±0.9 h, p=0.01) and DGF less (12% vs. 24%, p=0.3); for SPK with no XM, cold ischemia was shorter (15.2±2 vs. 18±0.9 h, p=0.1); no diff in DGF. All post-XM were negative and there were no hyperacute rejections; there was no diff in acute rejection episodes. Actuarial 1 yr graft survival: no XM-K=87.5%, SKP=82%; Yes XM-K=88%, SKP=86% (NS). Our data suggest it is safe, in select circumstances, to proceed to the OR without a XM. Elimination of the screening XM for 0% PRA candidates saves money. Proceeding to the OR (if available) without a final XM shortens cold ischemia time.

AB - Given the constant flux in caseload and the number of personnel available in the OR, waiting for a final XM often prolongs organ preservation time (a room available at the time a XM is started is not available when the XM is completed). Longer preservation is associated with increased DGF and decreased graft survival. We have shown in a retrospective analysis that final XMs on 0% PRA recipients were always negative (Transplantation, 1999). We now describe a policy of: a) not doing screening XM and b) proceeding to the OR without a XM, in situations where the recipients's PRA has been documented to be 0% and when there have not been any interim transfusions (and the OR is ready before XM completion). Final XM is completed after the transplant. All patients send sera every 6 weeks for PRA (antiglobulin technique). If ≥3 consecutive PRAs are 0%, no donar-specific screening XM is done prior to calling the patient in for tx (UNOS allocation algorithm used). If there have not been any interim transfusions, we have proceeded to tx prior to completion of the final XM. Between 1 January 1998 and 31 December 1999, we did 109 CAD kidney (K) and 79 simultaneous kidney pancreas (SPK) tx; 67 (61%) K and 56 (71%) SPK had 0% PRA. Of the 0% PRA, 25/67 (37%) K and 28/56 (50%) SPK had no pretx XM. For K with no XM, cold ischemia was shorter (13.2±0.2 vs. 18±0.9 h, p=0.01) and DGF less (12% vs. 24%, p=0.3); for SPK with no XM, cold ischemia was shorter (15.2±2 vs. 18±0.9 h, p=0.1); no diff in DGF. All post-XM were negative and there were no hyperacute rejections; there was no diff in acute rejection episodes. Actuarial 1 yr graft survival: no XM-K=87.5%, SKP=82%; Yes XM-K=88%, SKP=86% (NS). Our data suggest it is safe, in select circumstances, to proceed to the OR without a XM. Elimination of the screening XM for 0% PRA candidates saves money. Proceeding to the OR (if available) without a final XM shortens cold ischemia time.

KW - Crossmatch

KW - Kidney

KW - Transplantation

UR - http://www.scopus.com/inward/record.url?scp=0034910772&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0034910772&partnerID=8YFLogxK

U2 - 10.1034/j.1399-0012.2001.150403.x

DO - 10.1034/j.1399-0012.2001.150403.x

M3 - Article

C2 - 11683816

AN - SCOPUS:0034910772

VL - 15

SP - 236

EP - 239

JO - Clinical Transplantation

JF - Clinical Transplantation

SN - 0902-0063

IS - 4

ER -