Overcoming a positive crossmatch in living-donor kidney transplantation

Am J Transplant. 2003 Aug;3(8):1017-23. doi: 10.1034/j.1600-6143.2003.00180.x.


Many patients who have an otherwise acceptable living-kidney donor do not undergo transplantation because of the presence of antibodies against the donor cells resulting in a positive crossmatch. In the current study, 14 patients with a positive cytotoxic crossmatch (titer </= 1 : 16) against their living donor underwent a regimen including pretransplant plasmapheresis, intravenous immunoglobulin, rituximab and splenectomy. Eleven of 14 grafts (79%) are functioning well 30-600 days after transplantation. Two grafts were lost to accelerated vasculopathy and one was lost to death with good function. No hyperacute or cellular rejections occurred. Antibody-mediated rejection occurred in six patients [two clinical (14%) and four subclinical (29%)] and was reversible with plasmapheresis and steroids. Our results suggest that selected crossmatch-positive patients can be transplanted successfully with living-donor kidney allografts, using a protocol of pretransplant plasmapheresis, intravenous immunoglobulin, rituximab and splenectomy. Longer follow-up will be needed, but the absence of anti-donor antibody and good early outcomes are encouraging.

MeSH terms

  • Adult
  • Antibodies / administration & dosage
  • Antibody Specificity
  • Antigens, CD20 / immunology
  • Female
  • Graft Survival
  • Humans
  • Immunoglobulins, Intravenous / administration & dosage
  • Kidney Function Tests
  • Kidney Transplantation*
  • Living Donors*
  • Male
  • Middle Aged
  • Splenectomy


  • Antibodies
  • Antigens, CD20
  • Immunoglobulins, Intravenous