title: Antibody-mediated rejection of renal allograft in combined liver-kidney transplant.
abstract: Liver transplantation is performed based on ABO blood type compatibility without dependence on crossmatch results. Combined liver-kidney transplantation (CLKT) is similarly performed without dependence of crossmatch results as the liver is thought to confer protection to the renal allograft against alloantibody. We report a case of CLKT in a sensitized patient with antibody-mediated rejection (AMR) of the renal allograft. AMR was confirmed with C4d staining and serial monitoring of donor-specific antibody (DSA). Despite intensive therapy directed against AMR and the presence of the liver allograft, the patient demonstrated increasing titers of alloantibody, never demonstrated adequate renal function, and ultimately expired after two months. This result demonstrates the potential for AMR of the renal allograft in sensitized recipients of CLKT.
authors.affiliation: Division of Transplantation, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA. rbarth@smail.umaryland.edu
authors.forename: Rolf N
authors.initials: RN
authors.lastname: Barth
authors.forename: Luis
authors.initials: L
authors.lastname: Campos
authors.forename: Debra L
authors.initials: DL
authors.lastname: Kukuruga
authors.forename: Cinthia
authors.initials: C
authors.lastname: Drachenberg
authors.forename: Benjamin
authors.initials: B
authors.lastname: Philosophe
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology; D015935:Complement C4b / Q000378:metabolism; D006084:Graft Rejection / Q000276:immunology* / Q000473:pathology; D006680:HLA Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007518:Isoantibodies / Q000276:immunology*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology*; D016031:Liver Transplantation / Q000009:adverse effects / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000378:metabolism; D011183:Postoperative Complications; D006435:Renal Dialysis; D014184:Transplantation, Homologous
chemical_list: D000017:ABO Blood-Group System; D006680:HLA Antigens; D007518:Isoantibodies; D010446:Peptide Fragments; D015935:Complement C4b; C032261:complement C4d