title: Class II alloantibody and mortality in simultaneous liver-kidney transplantation.
abstract: Hyperacute kidney rejection is unusual in crossmatch positive recipients of simultaneous liver-kidney transplants (SLKT). However, recent data suggest that these patients remain at risk for antibody-mediated kidney rejection. To further investigate the risk associated with donor-specific alloantibodies (DSA) in SLKT, we studied 86 consecutive SLKT patients with an available pre-SLKT serum sample. Serum samples were analyzed in a blinded fashion for HLA DSA using single antigen beads (median florescence intensity≥2,000=positive). Post-SLKT samples were analyzed when available (76%). Thirty patients had preformed DSA, and nine developed de novo DSA. Preformed class I DSA did not change the risk of rejection, patient or allograft survival. In contrast, preformed class II DSA was associated with a markedly increased risk of renal antibody mediated rejection (AMR) (p=0.006), liver allograft rejection (p=0.002), patient death (p=0.02), liver allograft loss (p=0.02) and renal allograft loss (p=0.045). Multivariable modeling showed class II DSA (preformed or de novo) to be an independent predictor of patient death (HR=2.2; p=0.043) and liver allograft loss (HR=2.2; p=0.044). These data warrant reconsideration of the approach to DSA in SLKT.
authors: Annette C. & Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX.
authors: J G
authors: JG
authors: O'Leary
authors: Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA.
authors: H M
authors: HM
authors: Gebel
authors: Annette C. & Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX.
authors: R
authors: R
authors: Ruiz
authors: Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA.
authors: R A
authors: RA
authors: Bray
authors: Annette C. & Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX.
authors: J D
authors: JD
authors: Marr
authors: Department of Pathology, Baylor University Medical Center, Dallas, TX.
authors: X J
authors: XJ
authors: Zhou
authors: Department of Pathology, Baylor University Medical Center, Dallas, TX.
authors: S M
authors: SM
authors: Shiller
authors: Annette C. & Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX.
authors: B M
authors: BM
authors: Susskind
authors: Department of Surgery, Emory University, Atlanta, GA.
authors: A D
authors: AD
authors: Kirk
authors: Annette C. & Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX.
authors: G B
authors: GB
authors: Klintmalm
mesh_terms: D000328:Adult; D001706:Biopsy; D005260:Female; D006084:Graft Rejection / Q000276:immunology; D006085:Graft Survival / Q000276:immunology; D000949:Histocompatibility Antigens Class II / Q000276:immunology*; D006801:Humans; D007518:Isoantibodies / Q000097:blood / Q000145:classification*; D016030:Kidney Transplantation / Q000379:methods*; D017093:Liver Failure / Q000401:mortality* / Q000628:therapy; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012042:Registries; D051437:Renal Insufficiency / Q000401:mortality* / Q000628:therapy; D012307:Risk Factors; D014184:Transplantation, Homologous; D055815:Young Adult
chemical_list: D000949:Histocompatibility Antigens Class II; D007518:Isoantibodies