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.
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).
|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|
|99||99||96||2,1,2||Positive||Positive||A2:17600 A32:18700 DR4:13400||N|
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.
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 April 25, 2019.
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