Abstract
Background: A pretransplant positive crossmatch in combined liver kidney transplants (CLK) is not considered a contraindication based on the reported immunoprotection conferred by the liver allograft. However, antibody-mediated rejection of the kidney in CLK has been reported recently. This prompted our study to investigate the impact of presensitization on CLK recipient outcomes. Methods: We examined kidney allograft and patient survival by indication of sensitization using Scientific Registry of Transplant Recipients data on CLK performed from 1995 to 2008. We defined sensitization as panel reactive antibody (PRA) more than 10% or a positive T-cell crossmatch (TXM). Results: Among 2484 CLK recipients with available PRA or TXM information, 30% had positive TXM or PRA more than 10%. Among those with TXM information, 12% had a positive crossmatch (n=234). In univariate analyses, patient (P=0.002) and overall kidney graft survival (P=0.015) were significantly diminished among sensitized patients. Differences in patient survival translated to estimated half-lives of 10.3 years among nonsensitized recipients versus 7.8 years among sensitized recipients, In multivariable Cox models, allosensitization was independently associated with patient death (adjusted hazard ratio=1.22, 95% CI, 1.04-1.43) and overall kidney graft loss (adjusted hazard ratio=1.16, 95% CI, 1.00-1.36). Conclusions: These results suggest a negative impact of presensitization on patient and overall renal allograft survival in CLK. Accordingly, presensitization may need to be considered in risk stratification and clinical management of CLK.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1286-1292 |
| Number of pages | 7 |
| Journal | Transplantation |
| Volume | 91 |
| Issue number | 11 |
| DOIs | |
| State | Published - Jun 15 2011 |
| Externally published | Yes |
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Keywords
- Allograft survival
- Allosensitization
- Combined transplants
- Kidney transplantation
- Liver transplantation
- Patient survival
ASJC Scopus subject areas
- Transplantation
Cite this
Combined liver-kidney transplants : Allosensitization and recipient outcomes. / Askar, Medhat; Schold, Jesse D.; Eghtesad, Bijan; Flechner, Stuart M.; Kaplan, Bruce; Klingman, Lynne; Zein, Nizar N.; Fung, John; Srinivas, Titte R.
In: Transplantation, Vol. 91, No. 11, 15.06.2011, p. 1286-1292.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Combined liver-kidney transplants
T2 - Allosensitization and recipient outcomes
AU - Askar, Medhat
AU - Schold, Jesse D.
AU - Eghtesad, Bijan
AU - Flechner, Stuart M.
AU - Kaplan, Bruce
AU - Klingman, Lynne
AU - Zein, Nizar N.
AU - Fung, John
AU - Srinivas, Titte R.
PY - 2011/6/15
Y1 - 2011/6/15
N2 - Background: A pretransplant positive crossmatch in combined liver kidney transplants (CLK) is not considered a contraindication based on the reported immunoprotection conferred by the liver allograft. However, antibody-mediated rejection of the kidney in CLK has been reported recently. This prompted our study to investigate the impact of presensitization on CLK recipient outcomes. Methods: We examined kidney allograft and patient survival by indication of sensitization using Scientific Registry of Transplant Recipients data on CLK performed from 1995 to 2008. We defined sensitization as panel reactive antibody (PRA) more than 10% or a positive T-cell crossmatch (TXM). Results: Among 2484 CLK recipients with available PRA or TXM information, 30% had positive TXM or PRA more than 10%. Among those with TXM information, 12% had a positive crossmatch (n=234). In univariate analyses, patient (P=0.002) and overall kidney graft survival (P=0.015) were significantly diminished among sensitized patients. Differences in patient survival translated to estimated half-lives of 10.3 years among nonsensitized recipients versus 7.8 years among sensitized recipients, In multivariable Cox models, allosensitization was independently associated with patient death (adjusted hazard ratio=1.22, 95% CI, 1.04-1.43) and overall kidney graft loss (adjusted hazard ratio=1.16, 95% CI, 1.00-1.36). Conclusions: These results suggest a negative impact of presensitization on patient and overall renal allograft survival in CLK. Accordingly, presensitization may need to be considered in risk stratification and clinical management of CLK.
AB - Background: A pretransplant positive crossmatch in combined liver kidney transplants (CLK) is not considered a contraindication based on the reported immunoprotection conferred by the liver allograft. However, antibody-mediated rejection of the kidney in CLK has been reported recently. This prompted our study to investigate the impact of presensitization on CLK recipient outcomes. Methods: We examined kidney allograft and patient survival by indication of sensitization using Scientific Registry of Transplant Recipients data on CLK performed from 1995 to 2008. We defined sensitization as panel reactive antibody (PRA) more than 10% or a positive T-cell crossmatch (TXM). Results: Among 2484 CLK recipients with available PRA or TXM information, 30% had positive TXM or PRA more than 10%. Among those with TXM information, 12% had a positive crossmatch (n=234). In univariate analyses, patient (P=0.002) and overall kidney graft survival (P=0.015) were significantly diminished among sensitized patients. Differences in patient survival translated to estimated half-lives of 10.3 years among nonsensitized recipients versus 7.8 years among sensitized recipients, In multivariable Cox models, allosensitization was independently associated with patient death (adjusted hazard ratio=1.22, 95% CI, 1.04-1.43) and overall kidney graft loss (adjusted hazard ratio=1.16, 95% CI, 1.00-1.36). Conclusions: These results suggest a negative impact of presensitization on patient and overall renal allograft survival in CLK. Accordingly, presensitization may need to be considered in risk stratification and clinical management of CLK.
KW - Allograft survival
KW - Allosensitization
KW - Combined transplants
KW - Kidney transplantation
KW - Liver transplantation
KW - Patient survival
UR - http://www.scopus.com/inward/record.url?scp=79958290840&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79958290840&partnerID=8YFLogxK
U2 - 10.1097/TP.0b013e3182184181
DO - 10.1097/TP.0b013e3182184181
M3 - Article
VL - 91
SP - 1286
EP - 1292
JO - Transplantation
JF - Transplantation
SN - 0041-1337
IS - 11
ER -