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REVIEW ARTICLE
Year : 2017  |  Volume : 17  |  Issue : 4  |  Page : 107-114

Case-based review of cross-match techniques in kidney transplantation


1 Department of Nephrology, Chitungwiza Central Hospital, Harare, Zimbabwe
2 Royal Liverpool University Hospital, Liverpool, UK
3 Sheffield Teaching Hospitals, Sheffield Kidney Institute, University of Sheffield, Sheffield, UK

Correspondence Address:
Dr. Ahmed Halawa
Sheffield Teaching Hospital, Herries Road, Sheffield S5 7AU
UK
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jesnt.jesnt_19_17

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To avoid renal allograft rejection and loss, human leucocyte antigen compatibility and lymphocytotoxic cross-matching of renal donors against prospective renal allograft recipients are obligatory and fundamental steps in pretransplant evaluation. The complement-dependent cytotoxicity assay has been the mainstay technique for ascertaining the presence of donor-specific antibodies since the 1970s. Improvement in the performance of cross-matching has seen the introduction of more sensitive and specific techniques such as flow cytometry, and highly sensitive enzyme-linked immunosorbent assay, Luminex platforms and virtual cross-match. This review article is an in-depth comparison of the advantages and disadvantages of each of the cross-match techniques. We demonstrate the application of these techniques through a clinical case scenario. A step-by-step analysis and interpretation of cross-match modalities of varying levels of sensitivity and specificity is needed to arrive at a pragmatic decision, which will lead to better transplantation outcome. In some patients with immunologically complex issues, a spectrum of cross-match techniques may be required for a safe outcome of transplant.


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