Outcomes of Sensitized Simultaneous Liver-Kidney Transplant
David Geffen School of Medicine, Los Angeles, CA
Meeting: 2022 American Transplant Congress
Abstract number: 1081
Keywords: Kidney/liver transplantation, Outcome, Sensitization
Topic: Clinical Science » Liver » 52 - Liver: Kidney Issues in Liver Transplantation
Session Information
Session Name: Liver: Kidney Issues in Liver Transplantation
Session Type: Poster Abstract
Date: Sunday, June 5, 2022
Session Time: 7:00pm-8:00pm
Presentation Time: 7:00pm-8:00pm
Location: Hynes Halls C & D
*Purpose: Pre-formed donor-specific HLA antibodies (DSAs) in simultaneous liver-kidney transplants (SLKTs) have been associated with increased risk of antibody mediated rejection (AMR) and negative transplant outcomes. There is a lack of consensus in immunosuppression management as well as immunogenic testing in this population. SLKT candidates at our center undergo HLA antibody testing at time of listing and single antigen testing (SAT) and crossmatch at time of transplant. We evaluated outcomes among sensitized (calculated PRA >30%, positive DSA, or positive crossmatch) and non-sensitized SLKTs at our center.
*Methods: We performed a single-center, retrospective review of adult de novo SLKTs performed between 2018-2021. All patients received basiliximab induction and maintenance immunosuppression with tacrolimus, mycophenolate, and prednisone. Primary outcomes were incidence of graft rejection and patient and graft survival at 1 year. Secondary outcome was development of de novo DSA.
*Results: Of 47 SLKTs, 13 were sensitized. 62% of patients in the sensitized group exhibited HLA Class II DSAs. Graft rejection was noted in 3 sensitized patients (2 kidney, 1 liver) and in 2 non-sensitized patients (1 kidney, 1 liver) and all were acute T-cell mediated. One non-sensitized patient experienced kidney graft failure while no sensitized patients did. No incidences of liver graft failure were reported in either group. No patients developed de novo DSAs. Death within the first year post transplant occurred in 2 sensitized patients and 1 non-sensitized patient.
*Conclusions: In this series of contemporary SLKTs, 27.7% were sensitized at the time of transplant. Sensitized patients exhibited a higher incidence of kidney rejection and death. There seemed to be no effect on the liver graft. Despite basiliximab induction, there were no cases of AMR and no development of de novo DSAs reported in either group. Overall differences may be related to sample size and longer follow-up may be needed to better assess long term outcomes including incidence of late onset AMR.
| Sensitized (n=13) | Non-sensitized (n=34) | |
| Age, mean | 57.6 | 54.7 |
| ETOH as cause of liver disease, n(%) | 5(38.5%) | 15(44.1) |
| HRS as cause of renal disease, n(%) | 11(84.6%) | 26(76.5%) |
| MELD at transplant (Median) | 38 | 37 |
| cPRA >30%, n(%) | 4(30.8%) | 0(0%) |
| Crossmatch positive, n(%) | 5(38.5%) | 0(0%) |
| Class I/II DSA positive, n(%) | 2(15.4%)/8(61.5%) | 0(0%)/1(2.9%) |
| Sensitized (n=13) | Non-sensitized (n=34) | |
| Graft loss, n(%) | 0(0%) | 1(2.9%) |
| Patient mortality within 1 year, n(%) | 2(15.4%) | 1(2.9%) |
| DGF, n(%) | 5(38.5%) | 18(52.9%) |
| Renal function (SCr, mg/dL), 6m median/1y median | 1.08/1.21 | 1.27/1.19 |
| Liver function (AST or ALT >3x normal upper limit), n(%) | 0(0%) | 0(0%) |
| Kidney rejection within 1 year, n(%) | 2(15.4%) | 1(2.9%) |
| Liver rejection within 1 year, n(%) | 1(7.7%) | 1(2.9%) |
To cite this abstract in AMA style:
Kitchel ER, Tan T, Wadhwa A, Farmer DG, Bunnapradist S. Outcomes of Sensitized Simultaneous Liver-Kidney Transplant [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/outcomes-of-sensitized-simultaneous-liver-kidney-transplant/. Accessed November 24, 2024.« Back to 2022 American Transplant Congress