Combined Liver-Kidney Transplants: Allosensitization and Recipient Outcomes

Askar, Medhat; Schold, Jesse D.; Eghtesad, Bijan; Flechner, Stuart M.; Kaplan, Bruce; Klingman, L.; Zein, Nizar N.; Fung, John J.; Srinivas, Titte R.

doi:10.1097/tp.0b013e3182184181

Cited by 45 publications

(43 citation statements)

References 26 publications

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“…There is a registry study of SLKT that reported higher mortality in sensitized recipients (positive pretransplant XM or PRA >10%). ( 21 ) Sensitization was associated with an increase of 20% in mortality and 16% of graft loss compared with unsensitized patients (HR, 1.22). In this study, time on dialysis, diabetes, and previous transplant were significantly more prevalent in sensitized patients.…”

Section: Discussionmentioning

confidence: 96%

“…( 19 ) In contrast, other authors have raised concerns about the allosensitization in SLKT and its negative impact on patient and overall renal allograft survival. ( 20‐22 ) In this sense, in LT, it has also been reported that preformed DSAs were associated with worse liver graft survival, biliary complications, and ductopenia. ( 23 ) Also, 1 registry study of SLKT reported higher mortality in sensitized recipients (positive pretransplant CDCXM or panel reactive antibody [PRA] titers >10%).…”

mentioning

confidence: 97%

“…( 23 ) Also, 1 registry study of SLKT reported higher mortality in sensitized recipients (positive pretransplant CDCXM or panel reactive antibody [PRA] titers >10%). ( 21 )…”

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confidence: 99%

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Kidney Graft Outcomes in High Immunological Risk Simultaneous Liver‐Kidney Transplants

et al. 2020

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Recipients of simultaneous liver‐kidney transplantations (SLKTs) have a lower risk of rejection compared with recipients of kidney transplants alone. However, there is disagreement about the impact of pretransplant anti–human leukocyte antigen sensitization on patient and kidney graft survival in the long term. The aim of the study was to evaluate the impact of the recipient immunological risk and comorbidities in renal graft outcomes on SLKT. We reviewed the SLKTs performed in our center from May 1993 until September 2017. Patient and graft survival were analyzed according to the immunological risk, comorbidities, liver and kidney rejection episodes, immunosuppression, and infections. A total of 20 recipients of SLKT were considered in the high immunological risk (HIR) group, and 68 recipients were included in the low immunological risk (LIR) control group. The prevalence of hepatitis C virus infection, second renal transplant, and time on dialysis prior to transplantation were significantly higher in the HIR group. The incidence of acute kidney rejection was higher in the HIR group (P<0.01). However, death‐censored kidney graft survival as well as the estimated glomerular filtration rate at follow‐up were not different between the 2 groups. Comorbidities, but not the immunological risk, impact negatively on patient survival. Despite the higher incidence of rejection in the HIR SLKT group, longterm renal function and graft survival were similar to the LIR group.

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Section: Discussionmentioning

confidence: 96%

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confidence: 97%

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Kidney Graft Outcomes in High Immunological Risk Simultaneous Liver‐Kidney Transplants

et al. 2020

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“…Analysis of the Scientific Registry of Transplant Recipients showed that only a minority of patients undergoing SLK usually receive lymphocyte-depleting agents as induction (14-19%), even among sensitized recipients. 9 Several centers use only an interleukin-2 receptor antagonist, such as basiliximab for induction in SLK transplants. 3,15,16 Our patient had a large amount of pre-formed anti-HLA donor-specific antibodies therefore, we targeted the antibody-mediated complement activation with eculizumab and B lymphocytes with rituximab.…”

Section: Discussionmentioning

confidence: 99%

“…8 In many transplant centers, SLK are allocated based only on ABO compatibility without consideration of crossmatch results or level of HLA sensitization in the recipient. 1,4,5,9 …”

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Successful Simultaneous Liver-Kidney Transplantation in the Presence of Multiple High-Titered Class I and II Antidonor HLA Antibodies

Paterno

Girnita

Brailey

et al. 2016

Transplantation Direct

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The results of simultaneous liver-kidney transplants in highly sensitized recipients have been controversial in terms of antibody-mediated rejection and kidney allograft outcomes. This case report provides a detailed and sophisticated documentation of histocompatibility and pathologic data in a simultaneous liver-kidney transplant performed in a recipient with multiple high-titered class I and II antidonor HLA antibodies and a strongly positive cytotoxic crossmatch. Patient received induction with steroids, rituximab, and eculizumab without lymphocyte depleting agents. The kidney transplant was delayed by 6 hours after the liver transplant to allow more time to the liver allograft to “absorb” donor-specific antibodies (DSA). Interestingly, the liver allograft did not prevent immediate antibody-mediated injury to the kidney allograft in this highly sensitized recipient. Anti-HLA single antigen bead analysis of liver and kidney allograft biopsy eluates revealed deposition of both class I and II DSA in both liver and kidney transplants during the first 2 weeks after transplant. Afterward, both liver and kidney allograft functions improved and remained normal after a year with progressive reduction in serum DSA values.

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Long‐term Outcomes after Liver Transplantation

Yeh¹,

Martins²,

Markmann³

2014

Textbook of Organ Transplantation

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Combined Liver-Kidney Transplants: Allosensitization and Recipient Outcomes

Abstract: These results suggest a negative impact of presensitization on patient and overall renal allograft survival in CLK. Accordingly, presensitization may need to be considered in risk stratification and clinical management of CLK.

Cited by 45 publications

References 26 publications

Kidney Graft Outcomes in High Immunological Risk Simultaneous Liver‐Kidney Transplants

Kidney Graft Outcomes in High Immunological Risk Simultaneous Liver‐Kidney Transplants

Successful Simultaneous Liver-Kidney Transplantation in the Presence of Multiple High-Titered Class I and II Antidonor HLA Antibodies

Long‐term Outcomes after Liver Transplantation

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