Renal Outcomes of Cross Match Positive Simultaneous Liver Kidney (SLK) Transplant Recipients Compared to Cross Match Positive Kidney Allograft Recipients

S. Vaishnav,¹ T. Taber,¹ W. Goggins,² S. Nagaraju,² J. Fridell,² A. Sharfuddin,¹ M. Yaqub,¹ D. Mishler,¹ M. Mujtaba.¹

¹IUSM, IU Health, Indianapolis, IN
²Surgery, Transplant, Indiana University School of Medicine, Indianapolis, IN.

Meeting: 2015 American Transplant Congress

Abstract number: 61

Keywords: Highly-sensitized, Kidney transplantation, Kidney/liver transplantation, Rejection

Session Information

Session Name: Concurrent Session: Optimizing Renal Outcomes in Liver Transplantation

Session Type: Concurrent Session

Date: Sunday, May 3, 2015

Session Time: 2:15pm-3:45pm

Presentation Time: 3:27pm-3:39pm

Location: Room 118-AB

The protective role of liver in cross-match(XM) positive SLK recipients and its impact on the incidence of renal antibody mediated rejection (AMR) is unclear.

A retrospective review of data from 9, CDC T/B, Flow XM positive recipients of staged SLK at our center since 2008 was performed. All patients received induction therapy with thymoglobulin + rituximab and maintained on CNI +/- MMF. Four patients underwent desensitization with plasmapheresis x2 sessions prior to kidney transplant. Two received post SLK IVIG and 2 received bortezomib.

We looked at incidence of AMR, serum creatinine and urine protein/creatinine ratio. We compared our findings with the previously published AMR rates in XM positive kidney transplant recipients from our center1. Chi-square without Yates correction with p value<0.05 considered to be significant.

Results:

Median follow-up was 635 days. 6 out of 9 patients had >20 months (600 days) follow-up. Two patients died from infection related complications. One patient (11%) had mix rejection AMR+ACR 18 days post-transplant. The mean serum creatinine level at 1 year 0.9 +/- 0.4 mg/dl. The mean urine protein/creatinine ratio at the last follow-up were 0.66 +/- 0.3. Incidence of AMR in XM+ kidney alone patients who underwent desensitization was 31% (19 out of 44), compared to 11% in SLK (p=0.03).

CROSS MATCH DATA ON INDIVIDUAL SLK PATIENT
PRA	Flow PRA C I	Flow PRA C II	MM	Flow T XM	Flow B XM	DSA (MFI)	AMR
99	51	59	1,1,2	Positive	Positive	A1: 2400 B 44: 6600 DR4: 8100 DQ8:11700	Y
11	44	0	1,2,1	Positive	Positive	NA	N
73	51	52	2,1,2	Positive	Positive	B81: 18000	N
97	89	82	1,2,1	Positive	Positive		N
99	99	96	2,1,2	Positive	Positive	A2:17600 A32:18700 DR4:13400	N
83	10	76	2,2,2	Negative	Positive	DQ4:19000 DQ7:17000	N
NA	46	23	2,2,1	Positive	Positive	NA	N
NA	41	15	2,2,2	Positive	Positive	B7:20,500	N
NA	64	73	2,2,2	Positive	Positive	NA	N

MM Mismatch, MFI Mean fluorescence intensity, NA Not available, PRA Panel reactive antibodies

Conclusions:

Incidence of renal AMR in highly cross match positive SLK recipients is low compared to cross match positive kidney transplant recipients. Liver appears to have a protective role.

Reference:

1: Mujtaba MA et al. Clin Transplant. 2011 Jan-Feb; 25(1):E96-102.¹¯

To cite this abstract in AMA style:

Vaishnav S, Taber T, Goggins W, Nagaraju S, Fridell J, Sharfuddin A, Yaqub M, Mishler D, Mujtaba M. Renal Outcomes of Cross Match Positive Simultaneous Liver Kidney (SLK) Transplant Recipients Compared to Cross Match Positive Kidney Allograft Recipients [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/renal-outcomes-of-cross-match-positive-simultaneous-liver-kidney-slk-transplant-recipients-compared-to-cross-match-positive-kidney-allograft-recipients/. Accessed November 21, 2024.

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