Class II alloantibody and mortality in simultaneous liver-kidney transplantation.
Published
Journal Article
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.
Full Text
Duke Authors
Cited Authors
- O'Leary, JG; Gebel, HM; Ruiz, R; Bray, RA; Marr, JD; Zhou, XJ; Shiller, SM; Susskind, BM; Kirk, AD; Klintmalm, GB
Published Date
- April 2013
Published In
Volume / Issue
- 13 / 4
Start / End Page
- 954 - 960
PubMed ID
- 23433356
Pubmed Central ID
- 23433356
Electronic International Standard Serial Number (EISSN)
- 1600-6143
Digital Object Identifier (DOI)
- 10.1111/ajt.12147
Language
- eng
Conference Location
- United States