How to Interpret a Virtual Crossmatch | Patient Case Quiz

A 54-year-old female with nonischemic cardiomyopathy status post axial flow left ventricular assist device, complicated by right ventricular failure status post magnetically levitated centrifugal right ventricular assist device, is referred for transplantation. She has had four pregnancies and required multiple blood transfusions after her assist devices were placed. Her calculated panel reactive antibodies (PRA) score is 93% (using a mean fluorescence intensity [MFI] threshold of 10,000), despite desensitization with intravenous immunoglobulin and rituximab. She undergoes further desensitization with plasmapheresis and bortezomib, which reduces her calculated panel reactive antibodies scores to 72%. She is listed Status 1A with a virtual crossmatch.

A suitable donor becomes available. The donor's human leucocyte antigen (HLA) is A1, B57, C35, DP2, DQ23, DR7. The patient's most recent panel reactive antibodies by single antigen bead assay listed by MFI are shown. As noted, an MFI >10,000 is considered strong-binding by the immunogenetics laboratory.

Patient's Panel Reactive Antibodies (PRA)
MFI >10,000: A2, A68, A69, B57, B58, DR1, DR103, DQ2
MFI >7,500: A24, DR9, DR51
MFI >5,000: A11, DR10, DR53, DQ5, DQ6
MFI <3,750: A1, A3, A23, B56, DR7

You decide to reject this potential donor.

Which of the following reasons do you give the organ procurement agency for rejecting the donor?

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