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Monocyte antigens may cause graft rejection.

Monocyte cross matching should be done before patients undergo renal transplantation, according to James Cerilli, MD, professor of surgery at Ohio State University. The technique involves obtaining an almost pure monocyte preparation from the kidney donor's WBCs and mixing this preparation with the recipient's serum. Then, Cerilli says, "You look to see if there is anything in the serum that kills those cells." This technique, he adds, is only moderately more difficult than standard cross matching. During the annual meeting of the American Society of Transplant Surgeons in Chicago, Cerilli reported on a preliminary study designed to evaluate the relationship between renal allograft survival and results of monocyte cross matching. "We attempted to show," he explains, "that patients who have antibody to [donor] monocytes do poorly, even when all the other immunologic parameters predict an excellent outcome." Earlier investigations by Peter Stastny, MD, of the University of Texas at Dallas