The donor/recipient matching in kidney transplantation is based on approved laboratory tests, which are complement-dependent cytotoxic crossmatch (CDC-XM) and flow cytometry crossmatch (FCXM). Both have some disadvantages: CDC-XM has low sensitivity, whereas FCXM does not differentiate between lytic vs. non-lytic alloantibodies. To find an improved method, we have developed a new crossmatch technique of cytolytic flow cytometry crossmatch (cFCXM), which allows for sensitive detection of clinically relevant complement-binding antibodies. The cFCXM assay detects dead cells with viability dye that ensue from the binding of allospecific lytic antibodies. In our study, 135 unsensitized kidney transplant recipients were recruited based on the CDC-XM and FCXM results and the clinical utility of cFCXM was evaluated. The 5-year follow-up for acute rejection incidents revealed that cFCXM could verify the clinical relevance of positive FCXM results as recipients with positive FCXM but negative CDC-XM had the same risk of rejection as patients with both negative CDC-XM/FCXM results. These findings suggest that cFCXM assay may provide more precise immunological risk assessment in kidney transplant recipients.

肾移植中的供体/受体匹配基于经批准的实验室测试，即补体依赖性细胞毒性交叉匹配 (CDC-XM) 和流式细胞术交叉匹配 (FCXM)。两者都有一些缺点：CDC-XM 灵敏度低，而 FCXM 不区分溶解性和非溶解性同种抗体。为了找到一种改进的方法，我们开发了一种新的溶细胞流式细胞术交叉匹配 (cFCXM) 交叉匹配技术，它可以灵敏地检测临床相关的补体结合抗体。cFCXM 检测用活性染料检测死细胞，这些染料是由同种异体特异性裂解抗体结合产生的。在我们的研究中，根据 CDC-XM 和 FCXM 结果招募了 135 名未致敏的肾移植受者，并评估了 cFCXM 的临床效用。对急性排斥事件的 5 年随访显示，cFCXM 可以验证 FCXM 阳性结果的临床相关性，因为 FCXM 阳性但 CDC-XM 阴性的受者与 CDC-XM/FCXM 结果均为阴性的患者具有相同的排斥风险. 这些发现表明，cFCXM 检测可以为肾移植受者提供更精确的免疫学风险评估。