Class II alloantibody and mortality in simultaneous liver-kidney transplantation

J. G. O'Leary*, H. M. Gebel, R. Ruiz, R. A. Bray, J. D. Marr, X. J. Zhou, S. M. Shiller, B. M. Susskind, A. D. Kirk, G. B. Klintmalm

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

80 Scopus citations

Abstract

Hyperacute kidney rejection is unusual in crossmatch positive recipients of simultaneous liver-kidney transplants (SLKT). However, recent data suggest that these patients remain at risk for antibody-mediated kidney rejection. To further investigate the risk associated with donor-specific alloantibodies (DSA) in SLKT, we studied 86 consecutive SLKT patients with an available pre-SLKT serum sample. Serum samples were analyzed in a blinded fashion for HLA DSA using single antigen beads (median florescence intensity ≥ 2,000 = positive). Post-SLKT samples were analyzed when available (76%). Thirty patients had preformed DSA, and nine developed de novo DSA. Preformed class I DSA did not change the risk of rejection, patient or allograft survival. In contrast, preformed class II DSA was associated with a markedly increased risk of renal antibody mediated rejection (AMR) (p = 0.006), liver allograft rejection (p = 0.002), patient death (p = 0.02), liver allograft loss (p = 0.02) and renal allograft loss (p = 0.045). Multivariable modeling showed class II DSA (preformed or de novo) to be an independent predictor of patient death (HR = 2.2; p = 0.043) and liver allograft loss (HR = 2.2; p = 0.044). These data warrant reconsideration of the approach to DSA in SLKT.

Original languageEnglish
Pages (from-to)954-960
Number of pages7
JournalAmerican Journal of Transplantation
Volume13
Issue number4
DOIs
StatePublished - Apr 2013
Externally publishedYes

Keywords

  • Antibody-mediated rejection
  • donor-specific antibodies
  • graft outcomes
  • liver transplant
  • renal transplant
  • simultaneous liver-kidney transplant

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