Correlation between Luminex donor-specific crossmatches and levels of donor-specific antibodies in pretransplantation screening

Abstract

Before kidney transplantation, recipients are routinely screened for preformed antibodies and prospective crossmatches. In this study, we compared prospective Luminex donor-specific crossmatches (LumXm) with the levels of identified, donor-specific antibodies (DSAs). LumXm was performed for 108 patient sera, 84 of which were positive for preformed antibodies and 24 of which were negative. Although LumXm can detect class I DSAs (anti-A and anti-B) with a mean fluorescence intensity (MFI) as low as 2300, the assay has a 'grey zone' for MFIs up to 4000 with a sensitivity of 54% and a specificity of 100%. LumXm can detect a class II DSA (anti-DRB1) with an MFI as low as 1300 and a sensitivity of 93% and a specificity of 99%. However, these correlations were obtained with two precautions: autocrossmatching and single-antigen bead assay with denaturing buffer were performed in discordant cases. Moreover, LumXm failed to detect anti-Cw and anti-DP in the 10 cases studied. LumXm, therefore, displays certain discrepancies with respect to single-bead assays--especially for antibodies with a low MFI. Unfortunately, LumXm has a low sensitivity for anti-A and anti-B class I antibodies.