title: Successful combined partial auxiliary liver and kidney transplantation in highly sensitized cross-match positive recipients.
abstract: Combined liver and renal transplantations can be performed against a positive cross-match, indicating that the liver protects the kidney from the harmful HLA antibodies. This led us to the hypothesis that a partial auxiliary liver graft may have a similar protective effect when performed together with the kidney in highly sensitized patients. Seven patients, with broadly reacting HLA antibodies and positive crossmatches, were transplanted with a partial liver and a kidney from the same donor. In one of the cases a living donor was used. We performed lymphocytotoxic and flow cross-matches before and after the transplantation. Cross-matches turned negative after grafting in five of seven cases. The kidney function was excellent, without rejections, during the follow-up (24-60 months) in these patients. In two cases the cross-match remained positive after transplantation, one with a never-functioning renal graft and the other with an early graft failure, probably due to humoral rejection. A simultaneous transplantation of a partial auxiliary liver graft from the same donor, with the sole purpose of protecting the kidney from harmful lymphocytotoxic antibodies, can be performed successfully despite a positive cross-match and may thus be a new option of treatment for highly sensitized patients waiting for a kidney transplant.
authors.affiliation: Department of Transplantation and Liver Surgery, Sahlgrenska Universith Hospital, Göteborg, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Olausson
authors.forename: L
authors.initials: L
authors.lastname: Mjörnstedt
authors.forename: G
authors.initials: G
authors.lastname: Nordén
authors.forename: L
authors.initials: L
authors.lastname: Rydberg
authors.forename: J
authors.initials: J
authors.lastname: Mölne
authors.forename: L
authors.initials: L
authors.lastname: Bäckman
authors.forename: S
authors.initials: S
authors.lastname: Friman
mesh_terms: D000328:Adult; D000961:Antilymphocyte Serum; D005260:Female; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007518:Isoantibodies; D007674:Kidney Diseases / Q000628:therapy*; D016030:Kidney Transplantation / Q000276:immunology / Q000379:methods*; D016031:Liver Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D014181:Transplantation Immunology; D016896:Treatment Outcome
chemical_list: D000961:Antilymphocyte Serum; D006680:HLA Antigens; D007518:Isoantibodies