Kidney transplantation in sensitized patients: Two case reports

Abstract

Dreaded complication of kidney transplantation in a sensitized patient is hyper-acute rejection immediately after vascular anastomosis. Although pretransplant complement-dependent cytotoxic cross match (CDC) has been the gold standard for many years, this assay is not perfect. The Luminex-based anti-HLA antibody detection assay is more sensitive and specific. While performing live-related kidney transplantation, luminex cross match is routinely performed but in a situation like deceased donor transplantation, in view of time constraints, we do CDC cross match and go ahead with transplantation if the result is negative (Cell lysis <10%). Here, we present two cases of deceased donor transplantation where CDC cross match was negative, based on this report, we went ahead with kidney transplantation but report of Luminex cross match turned out to be positive after the transplantation was already over. Both the recipients had the features of hyper acute rejection. One patient could be salvaged but the other lost the graft.

Keywords

• cytotoxic cross match cross match
• hyperacute rejection
• luminex cross match