Utility of Virtual Crossmatch in Sensitized Patients Awaiting Heart Transplantation

Josef Stehlik, Nauman Islam, Denise Hurst, Abdallah G. Kfoury, Matthew A. Movsesian, Ann Fuller, Julio C. Delgado, M. Elizabeth H. Hammond, Edward M. Gilbert, Dale G. Renlund, Feras Bader, Patrick W. Fisher, David A. Bull, Arun K. Singhal, David D. Eckels

Research output: Contribution to journalArticlepeer-review

65 Scopus citations

Abstract

Background: Organ transplant candidates with serum antibodies directed against human leukocyte antigens (HLA) face longer waiting times and higher mortality while awaiting transplantation. This study examined the accuracy of virtual crossmatch, in which recipient HLA-specific antibodies, identified by solid-phase assays, are compared to the prospective donor HLA-type in heart transplantation. Methods: We examined the accuracy of virtual crossmatch in predicting immune compatibility of donors and recipients in heart transplantation and clinical outcomes in immunologically sensitized heart transplant recipients in whom virtual crossmatch was used in allograft allocation. Results: Based on analysis of 257 T-cell antihuman immunoglobulin complement-dependent cytotoxic (AHG-CDC) crossmatch tests, the positive predictive value of virtual crossmatch (the likelihood of an incompatible virtual crossmatch resulting in an incompatible T-cell CDC-AHG crossmatch) was 79%, and the negative predictive value of virtual crossmatch (the likelihood of a compatible virtual crossmatch resulting in a compatible T-cell CDC-AHG crossmatch) was 92%. When used in a cohort of 28 sensitized patients awaiting heart transplantation, 14 received allografts based on a compatible virtual crossmatch alone from donors in geographically distant locations. Compared with the other 14 sensitized patients who underwent transplant after a compatible prospective serologic crossmatch, the rejection rates and survival were similar. Conclusion: Our findings are evidence of the accuracy of virtual crossmatch and its utility in augmenting the opportunities for transplantation of sensitized patients.

Original languageEnglish (US)
Pages (from-to)1129-1134
Number of pages6
JournalJournal of Heart and Lung Transplantation
Volume28
Issue number11
DOIs
StatePublished - Nov 2009
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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