title: Successful Simultaneous Liver-Kidney Transplantation in the Presence of Multiple High-Titered Class I and II Antidonor HLA Antibodies.
abstract: The results of simultaneous liver-kidney transplants in highly sensitized recipients have been controversial in terms of antibody-mediated rejection and kidney allograft outcomes. This case report provides a detailed and sophisticated documentation of histocompatibility and pathologic data in a simultaneous liver-kidney transplant performed in a recipient with multiple high-titered class I and II antidonor HLA antibodies and a strongly positive cytotoxic crossmatch. Patient received induction with steroids, rituximab, and eculizumab without lymphocyte depleting agents. The kidney transplant was delayed by 6 hours after the liver transplant to allow more time to the liver allograft to "absorb" donor-specific antibodies (DSA). Interestingly, the liver allograft did not prevent immediate antibody-mediated injury to the kidney allograft in this highly sensitized recipient. Anti-HLA single antigen bead analysis of liver and kidney allograft biopsy eluates revealed deposition of both class I and II DSA in both liver and kidney transplants during the first 2 weeks after transplant. Afterward, both liver and kidney allograft functions improved and remained normal after a year with progressive reduction in serum DSA values.
authors.affiliation: Division of Transplantation, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH.
authors.forename: Flavio
authors.initials: F
authors.lastname: Paterno
authors.affiliation: Division of Transplantation, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH.
authors.forename: Alin
authors.initials: A
authors.lastname: Girnita
authors.affiliation: Division of Transplantation, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH.
authors.forename: Paul
authors.initials: P
authors.lastname: Brailey
authors.affiliation: Division of Transplantation, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH.
authors.forename: David
authors.initials: D
authors.lastname: Witte
authors.affiliation: Division of Transplantation, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH.
authors.forename: Jiang
authors.initials: J
authors.lastname: Wang
authors.affiliation: Division of Transplantation, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH.
authors.forename: Madison C
authors.initials: MC
authors.lastname: Cuffy
authors.affiliation: Division of Transplantation, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH.
authors.forename: Tayyab
authors.initials: T
authors.lastname: Diwan
authors.affiliation: Division of Transplantation, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH.
authors.forename: Simon
authors.initials: S
authors.lastname: Tremblay
authors.affiliation: Division of Transplantation, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH.
authors.forename: Jane Y
authors.initials: JY
authors.lastname: Revollo
authors.affiliation: Division of Transplantation, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH.
authors.forename: Rita R
authors.initials: RR
authors.lastname: Alloway
authors.affiliation: Division of Transplantation, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Schoech
authors.affiliation: Division of Transplantation, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH.
authors.forename: Nadim
authors.initials: N
authors.lastname: Anwar
authors.affiliation: Division of Transplantation, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH.
authors.forename: Shimul A
authors.initials: SA
authors.lastname: Shah
authors.affiliation: Division of Transplantation, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH.
authors.forename: Steve E
authors.initials: SE
authors.lastname: Woodle