PMID- 16499585
OWN - NLM
STAT- MEDLINE
DCOM- 20060718
LR  - 20061115
IS  - 1397-3142 (Print)
IS  - 1397-3142 (Linking)
VI  - 10
IP  - 1
DP  - 2006 Feb
TI  - The virtual crossmatch--a screening tool for sensitized pediatric heart 
      transplant recipients.
PG  - 38-41
AB  - Heart transplantation in the setting of human leukocyte antigen (HLA) 
      sensitization is challenging, as a time-consuming prospective crossmatch (XM) may 
      be required, severely limiting the number of potential donors. We evaluated a 
      'virtual XM', defining a positive virtual XM as the presence of recipient 
      pre-formed anti-HLA antibodies to the prospective donor HLA type, and compared 
      the virtual XM to a standard direct XM. Bead-based flow cytometric analysis was 
      used to identify anti-HLA antibody (Ab) present in a child listed for heart 
      transplantation. Using recipient serum, direct-flow cytometric T- and B-cell XM 
      were run for potential donors against whose HLA type the recipient had specific 
      antibodies (group 1, n = 7) and for potential donors with predicted compatible 
      HLA types by virtual XM (group 2, n = 7). Results were expressed as median 
      channel difference (MCD) between the control and recipient serum. A positive 
      T-cell XM was defined as MCD > 50, whereas MCD > 100 constituted a positive 
      B-cell result. The rate of T-cell reactivity was significantly less in group 2 
      than in group 1 (29% vs. 100%, p = 0.02); similarly, B-cell reactivity was also 
      less for group 2 (14% vs. 100%, p = 0.005). The virtual XM was 100% sensitive in 
      detecting positive flow cytometric XM results for T and B cells. Although only 
      72% specific in predicting a negative T-cell XM, and 86% specific for negative 
      B-cell XM, the false negatives were weakly positive and would probably have been 
      clinically acceptable. Currently, potentially suitable donor organs are often 
      declined for lack of a prospective XM; these organs may ultimately be allocated 
      to more distant recipients or perhaps not used at all. While further studies are 
      needed, virtual XM has the potential to improve availability of organs for 
      sensitized patients and improve the overall allocation process.
FAU - Zangwill, S D
AU  - Zangwill SD
AD  - Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA. 
      szangwill@chw.org
FAU - Ellis, T M
AU  - Ellis TM
FAU - Zlotocha, J
AU  - Zlotocha J
FAU - Jaquiss, R D
AU  - Jaquiss RD
FAU - Tweddell, J S
AU  - Tweddell JS
FAU - Mussatto, K A
AU  - Mussatto KA
FAU - Berger, S
AU  - Berger S
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - Denmark
TA  - Pediatr Transplant
JT  - Pediatric transplantation
JID - 9802574
RN  - 0 (HLA Antigens)
SB  - IM
MH  - B-Lymphocytes/immunology
MH  - Child
MH  - Flow Cytometry
MH  - HLA Antigens/*analysis
MH  - Heart Transplantation/*immunology
MH  - Histocompatibility Testing/*methods
MH  - Humans
MH  - Predictive Value of Tests
MH  - Prospective Studies
MH  - T-Lymphocytes/immunology
EDAT- 2006/02/28 09:00
MHDA- 2006/07/19 09:00
CRDT- 2006/02/28 09:00
PHST- 2006/02/28 09:00 [pubmed]
PHST- 2006/07/19 09:00 [medline]
PHST- 2006/02/28 09:00 [entrez]
AID - PTR394 [pii]
AID - 10.1111/j.1399-3046.2005.00394.x [doi]
PST - ppublish
SO  - Pediatr Transplant. 2006 Feb;10(1):38-41. doi: 10.1111/j.1399-3046.2005.00394.x.