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Eur J Cardiothorac Surg 2000;17:362-369
© 2000 Elsevier Science NL

The clinical significance of flow cytometry crossmatching in heart transplantation

^a Section of Cardiac Transplantation and Mechanical Circulatory Assist Program, Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, OH, USA
^b Transplant Center Histocompatability Laboratory, Desk C100, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
^c Kaufman Center for Heart Failure, and Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, OH, USA
^d Department of Anatomic Pathology, The Cleveland Clinic Foundation, Cleveland, OH, USA
^e Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Cleveland, OH, USA

Corresponding author. Tel.: +1-216-444-2805; fax: +1-216-444-8261
e-mail: djc{at}tt.ccf.org

Objective: Flow cytometry crossmatching (FCXM) is more sensitive than the cytotoxic crossmatch in identifying preformed antibodies to donor alloantigens, but its clinical importance is controversial. The objective of this study was to determine the association of a FCXM with survival and incidence of vascular rejection in cardiac transplant recipients with a negative cytotoxic crossmatch. Methods: Between 1993 and 1998, 357 heart transplant recipients with a negative T cell cytotoxic crossmatch were studied by three-color FCXM to quantitate anti-donor IgG reactions against B and T lymphocytes. Reactions positive against both were consistent with human leukocyte antigen (HLA) Class I reactivity, and those against B cells only were considered to be against HLA Class II antigens. Endpoints were episodes of vascular rejection, death from acute and chronic rejection and overall survival. Results: Fifty patients were FCXM for Class I-positive, 144 for Class II-positive, and 163 were negative. At 1 month, freedom from vascular rejection was 64% in Class I patients, but 90% and 96% in Class II or negative crossmatch patients (P<0.0001). Survival of the negative crossmatch group was higher than either Class I or II groups (94%, 74% and 76%, respectively, at 3 years; P<0.0001). Death from acute rejection was 3% and 2% at 3 years in negative or Class II-positive patients, but 19% in Class I patients (P<0.0001). Death from chronic rejection occurred only in Class II patients (P=0.002). Conclusions: Despite a negative T-cell cytotoxic crossmatch, a positive flow cytometry crossmatch correlates with important clinical events after heart transplantation.

Key Words: Flow cytometry • Crossmatch • Survival • Vascular rejection

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