Limitation of the Lymphocyte Cytotoxicity Crossmatch Test in Recipients of Kidney Transplants Having Preformed Antileukocyte Antibodies

KIDNEY transplantation in recipients with donor-specific anti-HL-A antibodies is associated with hyperacute rejection of the transplant.1 These high-risk patients can be identified on the basis of a positive cytotoxic crossmatch test of the recipient's serum and donor's lymphocytes.2 In 15 per cent of cases, however, a graft may still be rapidly rejected even though the crossmatch is negative.3 A possible explanation for this discrepancy is suggested by the course of a 26-year-old man who received a kidney transplant from his mother. Immediate diuresis was followed by anuria 24 to 36 hours later. A biopsy showed hyperacute rejection.4 The transplanted kidney . . .