title: Donor-directed MHC class I antibody is preferentially cleared from sensitized recipients of combined liver/kidney transplants.
abstract: For patients with chronic renal and liver diseases, simultaneous liver and kidney transplantation (SLKT) is the best therapeutic option. The role of a pretransplant donor-specific antibody (DSA) in SLKT is unclear. We report the results of a retrospective review from 7/08 to 10/09 of SLKT at our institution. Monitoring of DSA was performed using single antigen bead assay. Between 7/08 and 10/09, there were six SLKT who had preformed DSA and positive XM (four class I and II DSA, one class I DSA only, one class II only). One-year patient and renal graft survival was 83%. Death-censored liver allograft survival was 100%. Acute humoral rejection (AHR) of the kidney occurred in 66% (three with both class I and II DSA and one with only class II DSA) of patients. In those with AHR, class I antibodies were rapidly cleared (p < 0.01) while class II antibodies persisted (p = 0.25). All patients who had humoral rejection of their kidney had preformed anticlass II antibodies. Liver allografts may not be fully protective of the renal allograft, especially with pre-existing MHC class II DSA. Long-term and careful follow-up will be critical to determine the impact of DSA on both allografts.
authors: Department of Surgery, Emory Transplant Center, Emory University School of Medicine, Atlanta, GA, USA.
authors: W
authors: W
authors: Dar
authors: A
authors: A
authors: Agarwal
authors: C
authors: C
authors: Watkins
authors: H M
authors: HM
authors: Gebel
authors: R A
authors: RA
authors: Bray
authors: K E
authors: KE
authors: Kokko
authors: T C
authors: TC
authors: Pearson
authors: S J
authors: SJ
authors: Knechtle
mesh_terms: D000918:Antibody Specificity; D005805:Genes, MHC Class I / Q000276:immunology*; D005802:Genes, MHC Class II / Q000276:immunology*; D006084:Graft Rejection / Q000276:immunology*; D006085:Graft Survival; D006650:Histocompatibility Testing; D006801:Humans; D007518:Isoantibodies / Q000276:immunology*; D016030:Kidney Transplantation / Q000276:immunology*; D016031:Liver Transplantation / Q000276:immunology*; D012189:Retrospective Studies; D014019:Tissue Donors; D014184:Transplantation, Homologous
chemical_list: D007518:Isoantibodies