Examining the Role for Donor-specific Antibody Testing in Simultaneous Liver-kidney Transplantation: A Single-center Analysis of Outcomes

Abstract

Background. Simultaneous liver-kidney transplantation (SLKT) is increasingly used for patients with concurrent end-stage liver and renal disease. Emerging evidence suggests that simultaneous liver transplant can provide a tolerogenic benefit to multiorgan transplant recipients. Posttransplant donor-specific antibody (DSA) may be associated with worse outcomes; however, the role for testing DSA in SLKT is unclear. Methods. This study retrospectively assessed the impact of DSA on outcomes following primary SLKT at a large-volume center between 2008 and 2018. Patients were grouped by positive DSA, negative DSA, and DSA not tested, and data were obtained from our institutional database and chart review. Results. The cohort included 138 SLKT recipients with a mean age of 56.1 ± 9.7 y; 61.6% were male, and 55.8% were Hispanic. Overall, 62 patients were tested for DSA posttransplant, and 33 patients (23.9%) had at least 1 DSA detected. A total of 34 patients (24.6%) experienced at least 1 episode of liver rejection, and 23 patients (16.7%) experienced kidney rejection. Over 50% of patients with de novo DSA changed status during their posttransplant course. Rates of both liver and kidney rejection were slightly higher in the DSA+ group, but liver allograft, kidney allograft, and patient survival did not differ when grouped by whether DSA testing was performed or DSA positivity. Conclusions. These data demonstrate that SLKT is associated with excellent long-term patient and allograft survival with a relatively low rate of rejection. In our experience, testing for DSA does not impact SLKT outcomes‚ and further multicenter analyses are needed to establish standard of care.

A-45-Year-Old Female, ABO Matched Living Related Kidney Transplant Recipient, Treatment Completed Hepatitis C Infection, Who Received Anti-Thymocyte Globulin as Induction Therapy Developed Pancytopenia and Acute Antibody Mediated Rejection Recovered with Plasmapheresis, Intravenous Immunoglobulin and Rituximab: Balancing Efficacy, Safety, and Cost!

“…Testing 'Donor specific antigen' (DSA) was one of the recommended tests in immunological screening in both living donor and deceased donor renal transplant. On the other hand, one study on simultaneous liver and kidney transplant (SLKT) involving 135 patients reported that SLKT is associated with excellent long-term patient and allograft survival with a relatively low rate of rejection; testing for DSA does not impact SLKT outcomes [16]. The point considered retrospectively was that 'it would be better to postpone the donor if ' AHG DTT B cell positive' in CDC cross match result'.…”