*Purpose: There is disagreement about the real impact of anti-HLA sensitization on patient and kidney graft survival in simultaneous liver-kidney transplant (SLKT).

*Methods: We reviewed the SLKT in our center between 1993 until 2017, and identified patients with criteria for high immunological risk (HIR), defined by a positive pre-transplant cytotoxicity crossmatch (CDC-CM), historic positive CDC-CM, positive flow cytometry crossmatch (FCC) or presence of donor-specific antibodies (DSA) prior to transplantation.

*Results: 88 SLKT were performed. Twenty (22.73%) met the criteria for HIR, 3 positive CDC-CM, 1 positive historic CDC-CM, 1 positive FCC, 1 positive FCC and DSA, 1 historic CDC and DSA, 3 positive CDC-CM and DSA, 2 positive CDC-CM, FCC and DSA, and 8 positive DSA patients. The prevalence of HCV, second transplant, and time on dialysis prior to transplantation was significantly higher in HIR group. Graft survival censoring death was not different between the two groups. Also, the impairment of estimated glomerular filtrate rate (eGFR) over time was not different. The kidney graft rejection was significantly higher in HIR patients, 30% vs 5.88% in NHIR, OR 6.86. Only three HIR patients had delayed graft function in the context of ABMR immediately post-transplant. The response to treatment was good in all the cases. In 6 of the 8 patients with positive CDC-CM, CM monitoring found negative FCC in all of them. The DSA were followed in 6 of the 15 DSA positive patients, 4 become negative and 2 remained positive, but with lower titles of MFI. Patient’s survival was lower in HIR patients, Log-Rank 0.027, mortality 45% vs 26.47% in HIR and NHIR respectively, HR 2.48. In univariate analysis, mortality was significantly associated with HIR (HR 2.49), HCV (HR 2.57), dialysis vintage (HR 2.58), and previous kidney transplant (HR 4.03). However, in a multivariate analysis, only previous kidney transplant retains significance, HR 3.33.

*Conclusions: Tolerance in SLKT is not complete, but it is clearly better than in isolated KT. The higher incidence of rejection in HIR patients was not associated with eGFR deterioration over time. Greater vigilance seems justified in HIR, at least in the early stages of transplantation. The weight of the alosensibilización in the survival of the graft and patient must be evaluated in relation to the comorbidities because sensitization is clearly associated with greater comorbidities.

« Back to 2019 American Transplant Congress