Figure 1228

Immunologic evaluation for cadaveric transplantation. Donors and recipients must have compatible blood groups. Tissue typing is carried out, and the degree of matching is used in the allocation of cadaveric organs. Some data suggest that the presence of human leukocyte antigen (HLA) mismatches that were also mismatched in a previous graft (especially at the DR locus) may lead to early graft loss. Thus, it may be wise to avoid these mismatches. When the percentage of panel reactive antibodies (PRA) is over 10%, tests may be carried out to determine whether some of the antibodies are autoreactive rather than alloreactive. Autoreactive antibodies may not increase the risk for graft loss as do alloreactive antibodies. The presence of high titers of alloreactive antibodies usually is due to previous pregnancies, transplantations, and blood transfusions. Determining antibody specificities may be useful in avoiding certain HLA antigens. In the highly sensitized patient (PRA > 50%) it may be difficult to find a complement-dependent cytotoxicity (CDC) cross-matched (X-match) negative donor. Avoiding blood transfusions may help the titer decrease over time. DTT—1, 4-dithiothre-itol (DTT). (From Kasiske and coworkers [1]; with permission.)

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