Date: Tuesday, June 5, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
SLK transplant recipients have excellent outcomes that rival kidney alone recipients in terms of graft and patient survival and have better outcomes in terms of rejection rates for both the cellular and antibody variants. It is mandatory to obtain a crossmatch prior to SLK transplant.
Aim: assess the effect of the presence of DSA or positive FCXM on outcomes.
Method: This is a retrospective single center study including all SLK recipients from March, 2013 to September, 2017. 36 patients were included in this study. 2 patients were excluded, one died within 1 month due to surgical complications and another had early liver graft thrombosis and required a retransplant. HLA antibody data was reviewed at time of transplant and on follow-up. Outcomes including graft and patient survival and function were tracked through November, 2017.
Results: 13 patients had DSA and out of those 6 had positive FCXM. 9/13 had cPRA>20% in the DSA group compared to 1/23 in the no-DSA group. 6 patients had Class I DSA, 4 Class II DSA, and 3 had both. Mean fluorescence intensity values ranged from 1000 – >18000. DSAs have resolved on post-transplant follow up in 9/11 patients. Rejection rates were low across the board. There was only one antibody mediated rejection in the no-DSA group. There were 2 deaths unrelated to graft function or rejection during follow up in the no-DSA group and none in the DSA group.
|DSA n=13||No-DSA n=23||p|
|Gender (F)||8 (61%)||7 (30%)||.06|
|DCD||4 (31%)||7 (30%)||NS|
|Delayed function Kidney||4 (30%)||11 (47%)||NS|
|Rejection Kidney||0 (0%)||3 (13%)||NS|
|Rejection Liver||1 (8%)||2 (9%)||NS|
|Creatinine at follow up||1.2±.1||1.3±.4||NS|
Immunosuppression induction was mainly with basiliximab except for 3 recipients with DSAs that displayed positive FCXM who received anti-thymocyte globulin. Maintenance was mainly with tacrolimus, mycophenolate mofetil, and prednisone was discontinued at day 90 post-transplant.
Conclusion: No significant difference in outcomes for SLK recipients regardless of DSA or FCXM status. At our center we do not list unacceptable antigens for SLK candidates.
CITATION INFORMATION: Khamash H., Kumar A., Aqel B., Heilman R., Jaramillo A., Reddy K., Moss A. No Deleterious Effect from the Presence of Donor Specific Antibodies (DSA) or Positive Flow Cytometry Crossmatch (FCXM) on the Outcomes of Simultaneous Liver-Kidney (SLK) Transplant Recipients Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Khamash H, Kumar A, Aqel B, Heilman R, Jaramillo A, Reddy K, Moss A. No Deleterious Effect from the Presence of Donor Specific Antibodies (DSA) or Positive Flow Cytometry Crossmatch (FCXM) on the Outcomes of Simultaneous Liver-Kidney (SLK) Transplant Recipients [abstract]. https://atcmeetingabstracts.com/abstract/no-deleterious-effect-from-the-presence-of-donor-specific-antibodies-dsa-or-positive-flow-cytometry-crossmatch-fcxm-on-the-outcomes-of-simultaneous-liver-kidney-slk-transplant-recipients/. Accessed December 6, 2019.
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