Improved flow cytometric detection of donor-specific HLA class II antibodies by heat inactivation

Flow cytometry is a powerful technique for T-cell crossmatching but is prone to false-positive reactions with B cells. In this study the flow cytometry crossmatch (FCXM) was performed in 319 cases, using the patient's serum untreated and incubated at 56 degrees C for 30 minutes. Heat treatment inhibited B-cell reactivity in 30 of 39 cases. Flow cytometry testing with latex beads coated with human leukocyte antigen (HLA) class II antigens showed no class II antibodies in sera that were completely inhibited by heat treatment. There was no inhibition of class I antibodies to either T or B cells, or of class II antibodies to B cells. Experiments with aggregated IgG showed that inhibition by heat treatment is likely due to the prevention of complement binding to aggregates or dissociation of aggregates, or both. We conclude that heat inactivation is a simple step that eliminates false-positive reactions in the B-cell flow cytometry crossmatch.