Elimination of pre-transplant cross-matching possible in some recipients:

            The august 2001 issue of clinical transplantation carries a report by Arthur Matas, MD and his colleagues from the University of Minnesota in Minneapolis on how waiting for a final cross match result can significantly delay organ transplantation and therefore prolong cold ischemia time. An operating room that is available when a cross match is started may not be available when the process is completed. The researchers developed a transplantation policy that eliminates pre-transplant cross matching thereby reducing time delays. The policy includes:

a)      Not performing a screening cross-match.

b)      Immediate transplantation for recipients with a 0% panel reactive antibody (PRA), provided they have not had any interim transfusions and the operating room is ready before cross-match completion.

c)      Final cross-match performed post transplantation.

The outcome of 109 patients who underwent kidney transplantation and 79 who underwent simultaneous pancreas-kidney (SPK) transplants between January 1998 and December 1999 were assessed to check the efficacy of the guideline of the policy. Of the 67 kidney and 56 SPK recipients who had a 0% PRA, 25 and 28 respectively had no pre-transplant cross-match. In kidney recipients with a 0 % PRA, the cold ischemia time was shorter and in fact the incidence of delayed graft function was noted. The post transplantation cross-matches of all 0% PRA recipients were negative. No hyper acute rejection occurred, and the incidence of acute rejection did not differ based on whether a pre-transplant cross match was performed or not. “The researchers have shown that for selected 0% PRA candidates, transplantation can be safely carried out without either a screening or a final cross match”.