Importance of the autocontrol crossmatch in human renal transplantation

The killing of donor cells in the standard lymphocyte crossmatch is considered strong evidence for preformed antibodies in the recipients's serum. Moreover, it is generally accepted that presensitization has occurred if any of the stored sera kill the donor cells. In our hands, if either the current or the stored sera kill the donor cells, it precludes transplantation. In nine cases we discovered that the recipient's sera also killed the recipient's own lymphocytes, a positive autocontrol test, indicating that factors other than conventional preformed cytotoxic antibodies were responsible for the positive standard crossmatch. The nine patients who demonstrated a positive standard crossmatch and a positive autocontrol for those sera received cadaver allografts. None of the kidneys were rejected hyperacutely and all are functioning adequately. We conclude that the autocontrol crossmatch is an important adjunct for uncovering false positive reactions in the standard lymphocyte crossmatch test.