期刊
AMERICAN JOURNAL OF TRANSPLANTATION
卷 13, 期 4, 页码 954-960出版社
WILEY-BLACKWELL
DOI: 10.1111/ajt.12147
关键词
Antibody-mediated rejection; donor-specific antibodies; graft outcomes; liver transplant; renal transplant; simultaneous liver-kidney transplant
资金
- NIDDK NIH HHS [T32 DK007191] Funding Source: Medline
Hyperacute kidney rejection is unusual in crossmatch positive recipients of simultaneous liverkidney 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.
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