Renal Graft Outcome in Simultaneous Kidney Transplantation Combined With Other Organs: Experience of a Single Center

Gutiérrez-Baños, J.L.; Portillo, J.A.; Ballestero, Roberto; Zubillaga, Sergio; Ramos, Enrique; Campos, J Aranha; Hidalgo, Ernest

doi:10.1016/j.transproceed.2008.06.111

Cited by 3 publications

(4 citation statements)

References 35 publications

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“…SLKT is becoming increasingly accepted as the standard of care for patients with both end-stage liver and kidney disease including patients highly sensitized to HLA antigens (8)(9)(10). Nonetheless, the role of HLA antibodies, specifically DSA, remains controversial.…”

Section: Discussionmentioning

confidence: 99%

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Donor-Directed MHC Class I Antibody Is Preferentially Cleared from Sensitized Recipients of Combined Liver/Kidney Transplants

Dar

Ágarwal

Watkins

et al. 2011

American Journal of Transplantation

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For patients with chronic renal and liver diseases, simultaneous liver and kidney transplantation (SLKT) is the best therapeutic option. The role of a pretransplant donor-specific antibody (DSA) in SLKT is unclear. We report the results of a retrospective review from 7/08 to 10/09 of SLKT at our institution. Monitoring of DSA was performed using single antigen bead assay. Between 7/08 and 10/09, there were six SLKT who had preformed DSA and positive XM (four class I and II DSA, one class I DSA only, one class II only). One-year patient and renal graft survival was 83%. Death-censored liver allograft survival was 100%. Acute humoral rejection (AHR) of the kidney occurred in 66% (three with both class I and II DSA and one with only class II DSA) of patients. In those with AHR, class I antibodies were rapidly cleared (p < 0.01) while class II antibodies persisted (p = 0.25). All patients who had humoral rejection of their kidney had preformed anticlass II antibodies. Liver allografts may not be fully protective of the renal allograft, especially with pre-existing MHC class II DSA. Long-term and careful follow-up will be critical to determine the impact of DSA on both allografts. Key words: Antibody-mediated rejection, kidney allograft, liver allograft Abbreviations: SLKT, simultaneous liver kidney transplantation; DSA, donor-specific antibody; AHR, acute humoral rejection; DTT, dithiothreitol; cMCF, delta mean channel fluorescence; MESF, molecules of equivalent soluble fluorescence; MFI, mean fluroescence intensity; AMR, antibody-mediated rejection; HLA, human leukocyte antigen; UNOS, United Network for Organ Sharing; MELD, modified end-stage liver disease; MHC, major histocompatibility complex; IVIG, intravenous immunoglobulin G.

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Section: Discussionmentioning

confidence: 99%

“…Nonetheless, the role of HLA antibodies, specifically DSA, remains controversial. Current published data indicate that kidneys are relatively protected from both antibody and cell-mediated rejection when cotransplanted with the liver in sensitized patients (3)(4)(8)(9)(10).…”

Section: Discussionmentioning

confidence: 99%

Donor-Directed MHC Class I Antibody Is Preferentially Cleared from Sensitized Recipients of Combined Liver/Kidney Transplants

Dar

Ágarwal

Watkins

et al. 2011

American Journal of Transplantation

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“…Most of the single-center studies descriptively analyzed their patient population without providing a matched-control group of single KTx recipients. 7,[9][10][11][14][15][16] In the present study we analyzed our heart and kidney transplantations over the current decade and compared outcomes with a matched group of single renal allograft recipients treated during the same time period.…”

Section: Discussionmentioning

confidence: 99%

Renal Graft Outcome in Combined Heart–Kidney Transplantation Compared to Kidney Transplantation Alone: A Single-Center, Matched-Control Study

Kebschull

Schleicher

Palmes

et al. 2012

Thorac cardiovasc Surg

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“…It is clear from multiple studies in the literature that the benefit of SLK is only seen in patients with >8 weeks of dialysis (6–9). These data are based solely on analysis of graft survival curves, but do not address those patients with intrinsic renal disease.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Simultaneous Liver/Kidney Transplants Are Equivalent to Kidney Transplant Alone: A Preliminary Report

et al. 2010

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Background With adoption of Model for End-stage Liver Disease (MELD), the number of simultaneous liver-kidney transplants (SLK) has greatly increased. A recent registry study questioned the equity of allocating kidney transplants (KTx) simultaneously with liver transplantation due to poor outcomes (1). Methods To investigate outcome of KTx in SLK, all SLK (n=36) performed at our center from 1/2000–12/2007 were reviewed and KTx outcomes compared to those of kidney transplant alone (KTA) performed during that period (n=1,283). We also reviewed whether pre-transplant panel reactive antibody (PRA) and donor specific antibody (DSA) affected KTx outcome in SLK. Results One- and three-year KTx and patient survival were not different between KTA and SLK regardless of sensitization level. There were 348 (27%) KTx failures in KTA vs. 6 (17%) in SLK (NS). Overall freedom from acute cellular rejection (ACR) and antibody-mediated rejection (AMR) in SLK was 93% and 96% at 3 years, compared to 72% and 78% in KTA (p=0.0105 and p=0.0744, respectively). Sensitized KTx recipients had more ACR and AMR (32% and 38%) at three years compared to non-sensitized recipients (28% and 20%) (p=0.23 and 0.0001, respectively). No differences in ACR and AMR were observed when SLK was divided and level of sensitization compared (p=0.17 and 0.65, respectively). Conclusion SLK is a life-saving procedure with excellent patient and graft survival. AMR incidence in the KTx appears reduced in SLK compared to KTA regardless of level of preoperative PRA. A high level of DSA should not preclude simultaneous transplantation when clinically indicated.

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Renal Graft Outcome in Simultaneous Kidney Transplantation Combined With Other Organs: Experience of a Single Center

Cited by 3 publications

References 35 publications

Donor-Directed MHC Class I Antibody Is Preferentially Cleared from Sensitized Recipients of Combined Liver/Kidney Transplants

Donor-Directed MHC Class I Antibody Is Preferentially Cleared from Sensitized Recipients of Combined Liver/Kidney Transplants

Renal Graft Outcome in Combined Heart–Kidney Transplantation Compared to Kidney Transplantation Alone: A Single-Center, Matched-Control Study

Outcomes of Simultaneous Liver/Kidney Transplants Are Equivalent to Kidney Transplant Alone: A Preliminary Report

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