The phone rings at night. You are asked whether to proceed with heart transplant if the donor-specific crossmatch is flow cytometry T cell positive, cytotoxicity negative. What do you do? The importance of positive T-cell donor-specific crossmatch by flow cytometry, yet cytotoxicity negative, has not yet been established. Furthermore, outcome for these patients after heart transplant may be poor. To evaluate this, we reviewed 216 patients who underwent heart transplant (with noninduction immunosuppression) between June 2000 and August 2003 in our program. We found 13 heart transplant patients who were retrospectively tested and found to be flow T-cell positive yet cytotoxicity negative.
Results None of the flow cytometry-positive, cytotoxicity-negative patients had hyperacute or delayed hyperacute rejection. Survival at 2 years was 100%. Only 1 of 13 patients had biopsy-proven rejection while 4 of 13 patients had any treated rejection (suggesting these patients had humoral rejection). No patients developed cardiac allograft vasculopathy within 2 years. For 203 control patients during the same time period, freedom from rejection was comparable (Table). Of these 13 study patients, 5 were also found to be B-cell positive by flow cytometry and cytotoxicity negative. Only 1 patient was found to be B-cell flow cytometry positive and cytotoxicity positive. This had no impact on outcome.
Conclusion T-cell flow cytometry-postive, cytotoxicity-negative donor-specific crossmatch appears safe to allow heart transplantation. A larger cohort of patients is needed to confirm this finding.
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