Combined Transplantation of Liver and Kidney From the Same Donor Protects the Kidney From Rejection and Improves Kidney Graft Survival

Rasmussen, Allan; Davies, Huw Alban; Jamieson, Neville V.; Evans, David B.; Calne, R. Y.

doi:10.1097/00007890-199503270-00025

Cited by 180 publications

(71 citation statements)

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“…In human beings, Calne's group showed that combined transplantation of liver and kidney from the same donor protects the kidney from rejection and improves kidney graft survival. (53) This observation has been reproduced by many teams, also in combined liver and lung transplantation. (54) In clinical liver transplantation, immunological tolerance, defined as a state of immunological unresponsiveness specific to the donor, was observed when LDLT was preceded by bone marrow transplant from the same human leukocyte antigen (HLA)-identical donor for hematologic disease.…”

Section: Immunological Privilege Of the Livermentioning

confidence: 74%

Pediatric liver transplantation: Personal perspectives on historical achievements and future challenges

Otté

2016

Liver Transpl

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This review presents the author's personal perspective and contributions to the first steps, the development, the current status, and the remaining issues of pediatric liver transplantation (LT). Innumerable children around the world who have undergone LT have reached adulthood. The techniques have reached maturity. As shown by my own group's experience, grafts donated by living donors might provide the best short-term and longterm results. Debate persists about the optimal immunosuppression (IS), although the place of tacrolimus remains unchallenged. Tolerance induction protocols aiming to induce microchimerism have been tried in clinical transplantation without convincing results. Withdrawal of maintenance IS is possible in some children who underwent liver transplantation who have excellent clinical status and normal liver function tests but is not without risk of rejection and subsequent worsening of histology. The current trend favored by the Brussels' group is to minimize IS as soon after transplant as possible, aiming to obtain a state of "prope" or "almost" tolerance. Liver grafts are threatened in the long term by increasing hepatitis-related fibrosis, resulting most likely from immunological assault. Nowadays, the focus is on the longterm survival, quality of life (growth, academic performance, employment, self-fulfillment, fertility, raising a family, etc.), induction of tolerance, prevention of risks bound to decades of IS (nephrotoxicity and neurotoxicity, cardiovascular risk, de novo malignancies, etc.), and prevention of graft fibrosis. All these issues are fertile fields for younger scientists.

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Section: Immunological Privilege Of the Livermentioning

confidence: 74%

Pediatric liver transplantation: Personal perspectives on historical achievements and future challenges

Otté

2016

Liver Transpl

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“…Early acute kidney rejection rates in combined transplantation are on average less than 10% (Table 10). 12,42,43,[46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61]65,80 This is compared with rejection rates of 30% to 50% reported in the literature for temporally matched kidney-only transplant recipients. 65 Thus, even with less HLA matching and a positive cross-match, renal rejection rates appear to be lower when a liver allograft is placed concurrently (Fig.…”

Section: Allograft Rejection After Lktmentioning

confidence: 99%

Identification of patients best suited for combined liver[ndash ]kidney transplantation: Part II

Davis

Gonwa

Wilkinson

2002

Liver Transplantation

116

105

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Liver-kidney transplantation (LKT) should be reserved for those recipients with primary disease affecting both organs. However, increasing transplant list waiting times have increased the development and duration of acute renal failure before liver transplantation. Furthermore, the need for posttransplant calcineurin inhibitors can render healing from acute renal failure difficult. Because of the increasing requests for and controversy over the topic of a kidney with a liver transplant (OLT) when complete failure of the kidney is not known, the following article will review the impact of renal failure on liver transplant outcome, treatment of peri-OLT renal failure, rejection rates after LKT, survival after LKT, and information on renal histology and progression of disease into the beginnings of an algorithm for making a decision about combined LKT. (Liver Transpl 2002;8:193-211.)

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“…Utilizing more sensitive methods of DSA detection and additional clinical endpoints, the results confirm earlier observations. 5 Several different mechanisms through which the liver resists DSA-mediated injury have been postulated, and these have been reviewed elsewhere. 6 However, recent investigations show us that this resistance is not absolute and can be overcome in patients with very high levels of circulating DSA, liver allograft dysfunction, or noncompliance with the immunosuppression.…”

mentioning

confidence: 99%

Liver Allograft Provides Immunoprotection for the Cardiac Allograft in Combined Heart–Liver Transplantation

Wong

Gandhi

Daly

et al. 2016

American Journal of Transplantation

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When transplanted simultaneously, the liver allograft has been thought to have an immunoprotective role on other organs; however, detailed analyses in simultaneous heart-liver transplantation (SHLT) have not been done to date. We analyzed patient outcomes and incidence of immune-mediated injury in 22 consecutive SHLT versus 223 isolated heart transplantation (IHT) recipients between January 2004 and December 2013, by reviewing 3912 protocol- and indication-specific cardiac allograft biopsy specimens. Overall survival was similar (86.4%, 86.4%, and 69.1% for SHLT and 93.3%, 84.7%, and 70.0% for IHT at 1, 5, and 10 years; p = 0.83). Despite similar immunosuppression, the incidence of T cell-mediated rejection (TCMR) was lower in SHLT (31.8%) than in IHT (84.8%) (p < 0.0001). Although more SHLT patients had preexisting donor-specific HLA antibody (22.7% versus 8.1%; p = 0.04), the incidence of antibody-mediated rejection was not different in SHLT compared with IHT (4.5% versus 14.8%, p = 0.33). While the left ventricular ejection fraction was comparable in both groups at 5 years, the incidence and severity of cardiac allograft vasculopathy were reduced in the SHLT recipients (42.9% versus 66.8%, p = 0.03). Simultaneously transplanted liver allograft was associated with reduced risk of TCMR (odds ratio [OR] 0.003, 95% confidence interval [CI] 0-0.02; p < 0.0001), antibody-mediated rejection (OR 0.04, 95% CI 0-0.46; p = 0.004), and cardiac allograft vasculopathy (OR 0.26, 95% CI 0.07-0.84; p = 0.02), after adjusting for other risk factors. These data suggest that the incidence of alloimmune injury in the heart allograft is reduced in SHLT recipients.

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Combined Transplantation of Liver and Kidney From the Same Donor Protects the Kidney From Rejection and Improves Kidney Graft Survival

Cited by 180 publications

References 0 publications

Pediatric liver transplantation: Personal perspectives on historical achievements and future challenges

Pediatric liver transplantation: Personal perspectives on historical achievements and future challenges

Identification of patients best suited for combined liver[ndash ]kidney transplantation: Part II

Liver Allograft Provides Immunoprotection for the Cardiac Allograft in Combined Heart–Liver Transplantation

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