Third cross-match?

[from.my.abdomen.to.yours]

So tomorrow my recipient and I have to go in for our third cross match? Our first came back that we were HLA incompatible, the surgeon then ordered another test to confirm. That test apparently wasn't sufficient and now we are doing yet another cross match...has anyone else had this many cross matches done? It really doesn't matter a whole lot if we aren't compatible because I have already decided to go forward with the paired exchange if I cannot donate directly to her...but why three? I just wish that all of this testing were over, it's really stressful...

And more bad news, my recipient has taken a turn for the worse...she's passing a lot of blood from her bladder (she hasn't made urine for over a year) and so her doctors are trying to sort that out, also her lungs are filling with fluid because the dialysis just isn't doing the trick any more...I'm getting really scared that she wont make it until the surgery...I have abandoned the idea of doing it over Christmas break after her recent string of bad luck...now we are just going to do it ASAP, but I am still worried...I wish I could push a fast-forward button!  :(

[lawphi]

Are you sure you were HLA incompatible or that the crossmatch came back positive?  My limited immunology knowledge shows that antigens will play a major role in a crossmatch. 

Having looked at the studies, the HLA antigen match is important, but shouldn't totally rule out a healthy donor.  The difference in longevity seems to be 10% higher over five years.  However, women seem to have lower graft survival rates than men. 

There are two parts to a crossmatch test and they are typically performed at the same time.  You have a T-Cell Flow Crossmatch and a B-Cell Flow Crossmatch.  In my experience, a T cell crossmatch takes 24 hours for the results and the B-Cell seems to take 48-72 hours.  You can read online regarding the different immune reactions.  If I recall correctly, a T Cell mild crossmatch is easier to suppress post transplant than a B-Cell.  If you had mild reactions, more testing would be ordered to determine the exact gene on the antigen that is responding positively. 

My husband is getting a kidney next week at John Hopkins.  He will have three crossmatches before the procedure and the final emergency crossmatch after plasmapheresis.

There are all kinds of formulas to determine the proper treatment.  When we received the kit for the second crossmatch to our pre-kidney, we were told they were trying a different matching formula for those with high PRAs.