Introduction: The risk of antibody mediated rejection (AMR) in simultaneous liver kidney (SLK) recipients is thought to be lower than in kidney alone patients due to protection by the liver against antibody damage. However, recent data challenge our understanding of antibody impact in these patients and suggest a role for donor-specific antibody (DSA) testing. We hypothesize that DSA assessment in SLK recipients will identify patients at increased immunologic risk and improve clinical management of this population.

Methods: We studied 36 SLK recipients at a tertiary care center who were transplanted after Luminex® single antigen bead (SAB) testing became routine [2008-2015]. Clinically significant DSA was defined as any DSA with a mean fluorescence intensity (MFI) > 3000. The average duration of follow-up was 3.3 ± 2.4 years.

Results: Screening for HLA antibody prior to SLK occurred in the majority of SLK recipients (25/36; 69%). Clinically significant levels of pre-transplant DSA were detected in 20% of this population. Pre-transplant DSA increased the frequency of post-transplant monitoring. In patients with detectable pre-transplant DSA, antibody persisted post-transplant in 100% and was associated with an increased rate of antibody-mediated rejection (AMR) in the kidney allograft. In contrast, the frequency of de novo DSA was low (5%) in low risk patients as defined by absence of pre-transplant DSA (Table).

Conclusion: DSA testing prior to transplant stratifies immunologic risk in SLK patients. In contrast to widely-held belief, DSA persists in higher risk patients and was associated with an increased frequency of graft rejection. Our results suggest a role for pre-transplant DSA testing and reconsideration of antibody impact in this patient population.

CITATION INFORMATION: Morrison A, Sawinski D, Kamoun M, Porrett P. Frequency and Utility of Donor-Specific Antibody Testing in Simultaneous Liver Kidney Transplant. Am J Transplant. 2016;16 (suppl 3).

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