*Purpose: It is known that renal transplant recipients with preformed donor specific antibodies (DSA) have poorer outcomes associated with episodes of acute rejection (AR) and suboptimal allograft function compared to their counterparts without sensitization. In contrast, simultaneous liver and kidney (SLK) transplantation can be performed with a positive cross match and significant preformed DSA with no notable decrease in graft function and survival. In a study of 65 patients who underwent SLK at our institution, our objective was to determine if the presence of class I or class II DSA had any adverse effect on renal allograft function and survival at one year.

*Methods: We retrospectively analyzed 65 SLK recipients in our institution from 2009-18. We measured DSA by single antigen assays looking at Class I HLA and Class II HLA with a positive threshold to be 2000 MFI. We categorized patients on whether they were positive for Class I or Class II DSA and evaluated for allograft outcomes and episodes of liver or kidney rejection. Patients received tacrolimus, mycophenolic acid, and steroids without antibody induction. Renal biopsies were performed for cause, not per protocol.

*Results: Our preliminary data show the mean patient age was 58 years, and 60% were male. The mean MELD score was 34. The etiology of cirrhosis was HCV in 25%, NASH 20%, Alcoholic Liver disease 14% and HCC 14%. Post SLK, 26% of the patients’ required continuous renal replacement therapy within 24 hours. At six months post-SLK, 47% of patients had an estimated glomerular filtration rate (eGFR) greater than 60mL/min/1.73m², and the average eGFR was 47mL/min/1.73m². At 12 months post-SLK, the eGFR was greater than 60 in 53% and the average eGFR at 12 months was 46mL/min/1.73m² for those with an eGFR less than 60 mL/min/1.73m². Patient survival one year post-SLK is 92%. Five patients expired within the first year of SLK. Two patients experienced an episode of acute liver rejection, and no patient had an episode of acute kidney rejection. There were no differences in the incidence of AR between patients with and without DSA, and renal function was similar at 12 months.

*Conclusions: The presence of either Class 1 or Class 2 DSA in patients undergoing simultaneous liver and kidney transplantation seems not to be associated with the incidence of rejection or worse renal function up to one year post transplantation.

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