Objectives: To determine the impact of pre-existing and de novo circulating anti-HLA antibodies (DSA or not, in simultaneous liver-kidney transplants (SLKT).
Methods: Thirty-nine adult recipients underwent an ABO-identical SLKT between 1988 and 2011, 11/39 patients had different degree of humoral sensitization; all recipients received an immunosuppressive regimen based on corticosteroids, a calcineurin inhibitor, an antimetabolite (mycophenolate mofetil or azathioprine) and induction therapy with either monoclonal (19/30) or polyclonal (20/39) antibodies.
Results: Acute kidney rejection (AKR) occurred in 3 patients (2 AHR, and 1 T-cell mediated); 8 patients developed post-transplant acute cellular liver rejection; neither type of maintenance immunosuppression, delayed graft function, HCV nor CMV infection influenced the development of AKR. Conversely, acute liver rejection (ALR) was numerically higher among patients receiving CsA as compared to those receiving TAC (p=0,08), but not related to induction therapy, HCV or CMV infection. A positive pre-transplant CDC crossmatch was obtained in 5/39 SLKT. Four of them did also show pre-transplant PRA>25%. Sensitized transplant recipients displayed a significantly higher incidence of AKR and those with a positive pre-transplant crossmatch developed Antibody-mediated AKR (P=0,038). On the contrary; all 8 patients developing T-cell mediated ALR had a negative crossmatch.
During the first year kidney and liver allograft function were not different, although a trend to numerically worsening kidney function was observed among sensitized patients.
Kaplan-Meier analysis of kidney allograft survival regarding the degree of pre-transplant peak of PRA sensitization showed that those SLKT recipients with a previous PRA>25% were at increased risk of kidney graft loss as compared to those with low or undetectable anti-HLA antibodies.
Conclusions: Liver allografts may not be fully protective of the renal allograft in terms of rejection or function, especially among sensitized patients.
To cite this abstract in AMA style:Bestard O, Cruzado J, Taco O, Lladó L, Melilli E, Fabregat J, Gil-Vernet S, Rafecas A, Grinyó J. Liver Allografts Do Not Always Protect from Kidney Allograft Rejection in Sensitized Recipients of Simultaneous Liver-Kidney Transplants [abstract]. Am J Transplant. 2013; 13 (suppl 5). http://atcmeetingabstracts.com/abstract/liver-allografts-do-not-always-protect-from-kidney-allograft-rejection-in-sensitized-recipients-of-simultaneous-liver-kidney-transplants/. Accessed November 24, 2017.
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