Simultaneous Liver-Kidney transplantation provides a mechanism to protect the transplanted kidney from recognition by the recipient's immune response compared to solitary kidney transplant alone. High levels of donor specific anti-HLA antibodies are present in the SLK patient's sera prior to transplant leading to positive crossmatch, yet these recipients have minimal antibody mediated rejection episodes post-transplant. The purpose of this study was to monitor donor specific anti-HLA antibodies and test for functional binding to donor cells by flow cytometry crossmatch over five key stages of the SLK transplant procedure: Pretransplant, Anaheptatic, Post Liver Txp, Post Kidney Txp and day 1 Post OP. In a representative case, the flow crossmatch channel shift, which represents direct binding of Anti-HLA Ab to donor cells, decreased over the length of the procedure 80 % post Liver and a further 14% post Kidney. Pretransplant donor specific anti-HLA antibody was detected against the DQ pair DQA1*03:01-DQB1*03:02 at 6365 MFI (mean fluorescence intensity) and a DQ3 family CREG group averaged 9174 MFI across 11 beads comprising the 55PP epitope. Over the course of the SLK procedure, DSA to DQA1*03:01 DQB1*03:02 decreased 64% (2278 MFI) and the DQ3 CREG group decreased 57% (3986 MFI) by post op day 1. The largest drop in donor specific anti-HLA antibody intensity was observed between the liver and kidney transplant procedures. During this phase of the procedure, the liver is perfused with recipient blood at which time donor specific antibodies begin to decrease and less binding to donor cells was observed. For highly sensitized SLK and kidney only recipients, this step represents a mechanism for endogenous desensitization, allowing transplant across an anti-HLA Ab barrier.

CITATION INFORMATION: Jindra P., Kueht M., Gray S., Giang D., Cusick M., Rana A., Murthy B., Etheridge W., Goss J., Kerman R. Assessment of Donor Specific Anti-HLA Antibodies throughout SLK Transplantation Am J Transplant. 2017;17 (suppl 3).

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