title: Outcomes of simultaneous liver and kidney transplantation in relation to a high level of preformed donor-specific antibodies.
abstract: BACKGROUND
  The protective effect of the liver allograft when simultaneously transplanted with a kidney in the setting of allosensitization is unclear.
  
  
  METHODS
  We analyzed the significance of sensitization, defined based on positive cytotoxicity crossmatches, positive flow cytometry crossmatches, and/or the presence of high levels of donor-specific antibodies, on the outcomes of simultaneous liver and kidney (SLK) transplantation. We reviewed 56 SLK performed at our center through December 31, 2011 and identified 13 patients who met high sensitization criteria.
  
  
  RESULTS
  Median patient survival was not significantly different: 86 months (95% confidence interval [CI], 47-135) for nonsensitized patients versus 151 months (95% CI, 4 to ∞) for sensitized patients (P=0.5). The 5-year survival was 67% (95% CI, 0.5-0.8) in the nonsensitized group and 64% (95% CI, 0.3-0.9) in the sensitized group. There were six renal allograft failures in the nonsensitized group but none in the sensitized group. The adjusted hazard ratios associated with the risk of death or the combined risk of death or renal allograft failure were 0.7 (95% CI, 0.1-3.8) and 0.4 (95% CI, 0.1-2.2) for sensitized versus nonsensitized patients. There were significantly more renal allograft rejections in the sensitized group (5 vs. 1; P=0.002) in the first year after transplantation, only one showing C4d positivity. Creatinine levels at 1 year after transplantation were similar: 1.5 mg/dL in the nonsensitized group versus 1.36 mg/dL in the sensitized group (P=0.6).
  
  
  CONCLUSIONS
  Sensitization does not appear to have a significant negative impact on the survival of SLK patients.
authors.affiliation: 1 University of Washington Medical Center, Seattle, WA. 2 Address correspondence to: Nicolae Leca, M.D., University of Washington Medical Center, 1959 NE Pacific Street, Box 356174, Seattle, WA.
authors.forename: Nicolae
authors.initials: N
authors.lastname: Leca
authors.forename: Paul
authors.initials: P
authors.lastname: Warner
authors.forename: Ramaswamy
authors.initials: R
authors.lastname: Bakthavatsalam
authors.forename: Karen
authors.initials: K
authors.lastname: Nelson
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Halldorson
authors.forename: Stephen
authors.initials: S
authors.lastname: Rayhill
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kendrick
authors.forename: Connie
authors.initials: C
authors.lastname: Davis
authors.forename: Jorge
authors.initials: J
authors.lastname: Reyes
mesh_terms: D000906:Antibodies / Q000276:immunology*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000276:immunology* / Q000401:mortality / Q000473:pathology; D006085:Graft Survival / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D016030:Kidney Transplantation; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015996:Survival Rate / Q000639:trends; D014019:Tissue Donors; D014184:Transplantation, Homologous; D014481:United States / Q000453:epidemiology
chemical_list: D000906:Antibodies