Overcoming a positive crossmatch in living-donor kidney transplantation

James M. Gloor, Steven R. DeGoeyb, Alvaro A. Pineda, S. Breanndan Moore, Mikel Prieto, Scott L. Nyberg, Timothy S. Larson, Matthew D. Griffin, Stephen C. Textor, Jorge A. Velosa, Thomas R. Schwab, Lynette A. Fix, Mark D. Stegall

Research output: Contribution to journalArticlepeer-review

227 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1017-1023
Number of pages7
JournalAmerican Journal of Transplantation
Issue number8
StatePublished - Aug 2003


  • Alloantibody
  • Intravenous immunoglobulin
  • Kidney transplantation
  • Plasmapheresis
  • Positive crossmatch
  • Sensitized patient

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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