title: Combined liver-kidney transplantation and the effect of preformed lymphocytotoxic antibodies.
abstract: Thirty-eight sequentially placed liver and kidney allografts were evaluated with respect to patient and graft survival, and the influence of preformed lymphocytotoxic antibodies was analysed. The results suggest that the survival rate of combined liver and kidney transplantation is similar to the survival rate of liver transplantation alone. Sequentially placed kidney allografts may be protected from hyperacute rejection in the presence of donor specific lymphocytotoxic antibodies, but not in all instances. Both patient and kidney allograft survival was lower in positive crossmatch patients (33% and 17% respectively) than in negative crossmatch patients (78% and 75%). High levels of panel reactive antibodies (> 10%) also appeared to have a deleterious effect on survival, although the majority of the patients who failed also had a positive crossmatch. Although performed lymphocytotoxic antibodies are not an absolute contraindication to combined liver-kidney transplantation, they do appear to have a deleterious effect on long-term graft survival. However, more correlation with clinical parameters is needed.
authors.affiliation: Department of Pathology, University of Pittsburgh School of Medicine.
authors.forename: S L
authors.initials: SL
authors.lastname: Saidman
authors.forename: R J
authors.initials: RJ
authors.lastname: Duquesnoy
authors.forename: A J
authors.initials: AJ
authors.lastname: Demetris
authors.forename: J
authors.initials: J
authors.lastname: McCauley
authors.forename: H
authors.initials: H
authors.lastname: Ramos
authors.forename: G
authors.initials: G
authors.lastname: Mazariegos
authors.forename: R
authors.initials: R
authors.lastname: Shapiro
authors.forename: T E
authors.initials: TE
authors.lastname: Starzl
authors.forename: J J
authors.initials: JJ
authors.lastname: Fung
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D007075:Immunoglobulin M / Q000276:immunology; D007165:Immunosuppression Therapy; D007518:Isoantibodies / Q000276:immunology*; D016030:Kidney Transplantation / Q000276:immunology* / Q000401:mortality; D015993:Life Tables; D016031:Liver Transplantation / Q000276:immunology* / Q000401:mortality; D008214:Lymphocytes / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D016019:Survival Analysis; D014019:Tissue Donors
chemical_list: D006680:HLA Antigens; D007075:Immunoglobulin M; D007518:Isoantibodies