title: Outcome of simultaneous liver-kidney transplantation in highly sensitized, crossmatch-positive patients.
abstract: BACKGROUND
  In simultaneous liver-kidney transplantation (SLKT), the liver has been described to protect the kidney from rejection, and acceptable results are possible despite a pretransplant positive crossmatch. At our center, 21 SLKT have been performed since 1993, 2 of them against a positive crossmatch.
  
  
  OBJECTIVE
  In this study we retrospectively analyzed two cases of SLKT after positive pretransplant crossmatch.
  
  
  METHODS
  Two highly sensitized women (30 and 52 years) with hepatic cirrhosis VHC on hemodialysis after a first KT failure were assessed. Pretransplant panel reactive antibodies (PRA) by complement dependent cytotoxicity NIH (CDC) were 81% and 99% respectively. Both patients received a SLKT. CM was performed at pretransplant and 24 and 48 hours posttransplant by CDC and by flow cytometry with double labeling with CD3-PE and antihuman IgG-FITC. Patients received ATG, cyclosporine, and prednisone therapy.
  
  
  RESULTS
  CM was positive pretransplant by CDC and flow cytometry. At 48 hours, CDC became almost negative (10%-20% mortality) and flow cytometry became negative. One of the patients experienced an episode of acute rejection at 10 days posttransplant that resolved with steroid pulses. Both patients presently have working grafts 26 and 24 months posttransplant (Cr, 1.1 and 1.5 mg/dL; GOT, 34 and 14 IU/L; GTP, 29 and 12 IU/L; GGT, 9 and 66 IU/L).
  
  
  CONCLUSIONS
  Our experience suggests that a positive crossmatch is not an absolute contraindication for SLKT. Good graft and patient survival rates are possible even among highly sensitized patients.
authors.affiliation: Renal Transplant Unit, Hospital Clínic, Barcelona, Spain. adalmau@clinic.ub.es
authors.forename: A
authors.initials: A
authors.lastname: Gutiérrez
authors.forename: M
authors.initials: M
authors.lastname: Crespo
authors.forename: J
authors.initials: J
authors.lastname: Mila
authors.forename: J V
authors.initials: JV
authors.lastname: Torregrosa
authors.forename: J
authors.initials: J
authors.lastname: Martorell
authors.forename: F
authors.initials: F
authors.lastname: Oppenheimer
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D005260:Female; D005434:Flow Cytometry; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology* / Q000502:physiology; D016031:Liver Transplantation / Q000276:immunology* / Q000502:physiology; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase