Successful kidney transplantation in the presence of IgM alloantibodies

The presence of anti‐donor IgM lymphocytotoxic antibodies in transplant recipient sera has been suggested as being clinically insignificant with regard to immediate and/or early graft survival. We have transplanted 20 cadaveric kidneys since June 1988 into recipients whose “extended standard crossmatch” was positive but whose crossmatch was negative after treating the sera with dithiothreitol (DTT). Within this group, 16 recipients received a primary kidney graft and 4 individuals had underlying connective tissue diseases. However, only one of these patients was auto‐crossmatch positive. Nine patients had a percent reactive antibody (pRA) level greater than 50% at the time of transplantation. Fourteen individuals had a positive T‐cell crossmatch, and all 20 had a positive B‐cell crossmatch. Seventeen of the 20 patients transplanted are alive. Four patients demonstrated delayed graft function. One patient died of pneumonia, 1 patient died of infectious complications, and 1 patient developed a coagulopathy and infarcted his kidney and mesenteric blood vessels. One patient had an accelerated humoral rejection which was reversed after plasmapheresis (X7). Fourteen of 20 recipients (70%), 13 of whom are 15 to 27 months posttransplant, are doing well with an average serum creatinine of 1.53 mg/dl. These results indicated that one can successfully transplant a kidney into a recipient whose positive crossmatch was due to IgM alloantibodies.