The significance of a donor-specific vessel crossmatch in renal transplantation

Very early graft rejection is usually attributed to pretransplant sensitization to HLA antigens represented on the lymphocyte. However, it is possible that such rejection episodes are secondary to antibody to a transplant-relevant system that is not represented on the lymphocyte but is represented within the allograft. This study suggests that sensitization to antigens on the VEC is detrimental to allograft success and can occur in the absence of sensitization to HLA antigens on the T or B cell or monocyte. When antibody to donor VEC is not present pretransplant, almost all patients (95%) will have a very benign posttransplant clinical course. When anti VEC antibody is present, early graft rejection or severe rejection episodes occur with a very high frequency (80%) in the nondiabetic patient. These observations, therefore, suggest that the pretransplant presence of antibody to VEC is detrimental to graft survival, and that such antibody can develop in the absence of anti HLA antibody. While the presence of such antibody is not an absolute contraindication to transplantation it does appear to represent a significant risk factor for immunological graft loss.