Hyperacute Rejection with negative cytotoxicity crossmatch in an HLA-based kidney allocation Brazilian organ sharing program – can we prevent?

Abstract

Since 1997, the Brazilian State of São Paulo has adopted an organ allocation program based on the criteria proposed by the United Network for Organ Sharing (UNOS). We report a case of a male kidney recipient with zero mismatch deceased donor transplant who evolved to hyperacute rejection, despite a negative conventional complement-dependent cytotoxicity crossmatch (CXM) for T and B lymphocytes. Patient was blood type AB with 2 previous blood transfusions and who presented recent and historical negative reactive antibodies panel against HLA class I, class II and MIC antigens. The CXM was repeated attaining the same previous results. Since no more donor cells were available, a T cell flow cytometry crossmatch (FCXM) was not performed. We discuss the economical impact, advantages and disadvantages as well as the feasibility of performing FCXM in all patients.