03397nas a2200421   4500008003900000245010500039210006900144260000800213300001300221490000700234520207800241653007302319653003302392653002202425653007302447653004102520653001102561653003202572653002602604653002602630653002402656653001702680653002202697653001702719100001602736700001602752700001702768700001702785700001402802700001302816700001902829700002102848700001402869700001302883700001602896700001402912856004902926       2005                          d00aHistocompatibility testing predicts acute rejection risk in early corticosteroid withdrawal regimens0 aHistocompatibility testing predicts acute rejection risk in earl  cMar  a809 - 110 v373 aHistocompatibility testing has been shown to predict acute rejection risk in steroid-based immunosuppression. However, little evidence exists of its ability to predict acute rejection risk in corticosteroid-free patients, with no evidence in early corticosteroid withdrawal (CSWD) under modern immunosuppression. The purpose of this study was to evaluate the ability of histocompatibility testing to identify patients at high risk for acute rejection after early CSWD. METHODS: One hundred eighty-one patients were entered into six IRB-approved early CSWD regimens. Histocompatibility testing included serologic PRA, flow cytometric PRA testing by Class I and Class II MHC beads, and B cell crossmatching with pronase treatment. All rejection episodes were biopsy proven, and grading was assigned using Banff criteria. Influence of individual tests was examined using Chi square univariate and multivariate logistic regression analysis. RESULTS: Median follow-up was 23.5 months (range 7-48 months). Of 181 patients, 16% were repeat transplant recipients, 36% received deceased donor renal transplants, 48% received living related donor renal transplants, and 16% received living unrelated transplants. Overall patient survival was 97%, and death-censored graft survival was 96.5%. Acute rejection rates in the entire follow-up period were 17.7%. 12.4% in primary transplant recipients and 37% in repeat transplant recipients. Multivariate analysis revealed that HLA AB and DR locus mismatching were associated with increased acute rejection risk. Similarly, serologic PRA analysis predicted acute rejection risk; however, flow cytometry crossmatching did not predict acute rejection risk. The greatest single influence on acute rejection risk appeared to be a flow cytometric B cell crossmatch (7.94-fold increased risk). In conclusion, histocompatibility testing can identify patients at high risk for acute rejection following early CSWD. HLA matching, serologic PRA testing, and flow cytometry-based B cell crossmatching can all be used to predict acute rejection risk.10aAdrenal Cortex Hormones / administration & dosage / *adverse effects10aDrug Administration Schedule10aFollow-Up Studies10aGraft Rejection / epidemiology / *immunology / mortality / pathology10aHistocompatibility Testing / methods10aHumans10aImmunosuppression / methods10aIsoantibodies / blood10aMultivariate Analysis10aRegression Analysis10aRisk Factors10aSurvival Analysis10aTime Factors1 aWoodle, E S1 aSusskind, B1 aAlloway, R R1 aHanaway, M J1 aThomas, M1 aBuell, J1 aAlexander, J W1 aRoy-Chaudhury, P1 aSuccop, P1 aCardi, M1 aBoardman, R1 aRogers, C  uhttps://www.notifylibrary.org/reference/1653