Combined liver-kidney transplants: Allosensitization and recipient outcomes

Medhat Askar, Jesse D. Schold, Bijan Eghtesad, Stuart M. Flechner, Bruce Kaplan, Lynne Klingman, Nizar N. Zein, John Fung, Titte R. Srinivas

    Research output: Contribution to journalArticlepeer-review

    32 Scopus citations

    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 languageEnglish (US)
    Pages (from-to)1286-1292
    Number of pages7
    JournalTransplantation
    Volume91
    Issue number11
    DOIs
    StatePublished - Jun 15 2011

    Keywords

    • Allograft survival
    • Allosensitization
    • Combined transplants
    • Kidney transplantation
    • Liver transplantation
    • Patient survival

    ASJC Scopus subject areas

    • Transplantation

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