title: Acute humoral rejection in an ABO compatible combined liver-kidney transplant--the kidney is not always protected.
abstract: Combined liver-kidney transplantation has become a common practice for the treatment of patients with concurrent end-stage renal disease and end-stage liver disease. Liver transplantation in the setting of multiorgan transplantation is thought to have a protective effect against humoral rejection even when a positive crossmatch is obtained prior to surgery. In most centers, a pre liver-kidney transplant crossmatch is rarely performed because of the known immunoprotective effect of the liver allograft. In this report, a case of acute humoral rejection in the kidney allograft after a combined liver-kidney transplant is described. Although humoral rejection was treated using plasmapheresis, intravenous immunoglobulin and rituximab, the kidney required 3 months to recover function and finally progressed to chronic allograft nephropathy. A heightened index of suspicion for acute humoral rejection of the renal allograft is necessary when performing combined liver-kidney transplants to highly sensitized patients due to previous organ transplants.
authors.affiliation: Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA. trevor.reichman@uchospitals.edu
authors.forename: T W
authors.initials: TW
authors.lastname: Reichman
authors.forename: S R
authors.initials: SR
authors.lastname: Marino
authors.forename: J
authors.initials: J
authors.lastname: Milner
authors.forename: R C
authors.initials: RC
authors.lastname: Harland
authors.forename: A
authors.initials: A
authors.lastname: Cochrane
authors.forename: J M
authors.initials: JM
authors.lastname: Millis
authors.forename: G
authors.initials: G
authors.lastname: Testa
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D006084:Graft Rejection / Q000175:diagnosis* / Q000276:immunology* / Q000628:therapy; D006648:Histocompatibility / Q000276:immunology*; D006801:Humans; D056724:Immunity, Humoral / Q000276:immunology*; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation / Q000276:immunology*; D008107:Liver Diseases / Q000601:surgery; D016031:Liver Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D000069283:Rituximab; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D000069283:Rituximab