Introduction: Simultaneous liver kidney transplant (SLK) recipients may be at risk of antibody-mediated kidney rejection (AMR) if the pre-transplant crossmatch is positive (+CXM). Accordingly, in 2014, we modified our SLK programme to include a flow crossmatch and increased immunosuppression (basiliximab induction, tacrolimus, MMF and prednisolone) for those with HLA class II DSAs MFI>10000 in whom a decision to proceed with +CXM SLK was made due to clinical urgency and cRF. All other patients receive tacrolimus and prednisolone. We report the results of the first 14 SLK transplants performed under the new risk stratification policy.

Methods: Cohort analysis of SLK recipients 2014-2016.

Results: Baseline variables are shown below. 2 patients had a retrospective B cell +CXM and class II DSAs with MFIs>10000. Both suffered with AMR at 1 week which was treated with plasma exchange and intravenous immunoglobulin (PEXivG). Current eGFR for these patients is 50 and 27 ml/min/1.73 m². A third patient developed grade 2A T cell mediated rejection (TCMR) at day 11 and was treated with ATG (current eGFR 39 ml/min/1.73 m²). One further patient developed 1A TCMR at 3 months. At 1 year, graft (liver and kidney) and patient survival was 100% with median eGFR of 46 ml/min/1.73 m² (32-94).

Discussion: Our results suggest that patients undergoing SLK transplantation with class II DSAs with MFIs>10000 and +CXM are at risk of AMR despite increased immunosuppression. However, AMR can be effectively treated with PEXivG. Further investigation to consider immunological risk stratification in SLK transplantation and optimal induction immunosuppression, by recruitment to a multicentre study is warranted.

CITATION INFORMATION: Shah S, Suddle A, Aluvihare V, Shaw O, Shaw C, Mamode N, Callaghan C, Koffman G, Heaton N. Risk of Kidney Rejection Following Simultaneous Liver Kidney Transplantation. Am J Transplant. 2017;17 (suppl 3).

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