Complement-Binding Anti-HLA Antibodies and Kidney Transplantation

To the Editor: Loupy et al. (Sept. 26 issue)(1) present data showing that the C1q-binding assay is more sensitive than the standard complement-dependent microlymphocytotoxicity (CDL) assay for assessing the risk of graft loss. In their retrospective analysis of 1016 patients who had a negative CDL assay before transplantation, antibody-mediated rejection developed in 7.4% during the first year. The authors predict that antibody-mediated rejection would have occurred in 3.7% of patients (a 50% reduction) if the C1q-binding assay had been used. However, most laboratories use a more sensitive flow cytometric crossmatching (FCXM),(2) not CDL alone. We have data from 11 patients ...