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 journalArticle

20 Citations (Scopus)

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
Externally publishedYes

Fingerprint

Kidney
Liver
Transplants
Allografts
Antibodies
Transplant Recipients
Survival
Graft Survival
Proportional Hazards Models
Registries
T-Lymphocytes

Keywords

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

ASJC Scopus subject areas

  • Transplantation

Cite this

Askar, M., Schold, J. D., Eghtesad, B., Flechner, S. M., Kaplan, B., Klingman, L., ... Srinivas, T. R. (2011). Combined liver-kidney transplants: Allosensitization and recipient outcomes. Transplantation, 91(11), 1286-1292. https://doi.org/10.1097/TP.0b013e3182184181

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 journalArticle

Askar, M, Schold, JD, Eghtesad, B, Flechner, SM, Kaplan, B, Klingman, L, Zein, NN, Fung, J & Srinivas, TR 2011, 'Combined liver-kidney transplants: Allosensitization and recipient outcomes', Transplantation, vol. 91, no. 11, pp. 1286-1292. https://doi.org/10.1097/TP.0b013e3182184181
Askar M, Schold JD, Eghtesad B, Flechner SM, Kaplan B, Klingman L et al. Combined liver-kidney transplants: Allosensitization and recipient outcomes. Transplantation. 2011 Jun 15;91(11):1286-1292. https://doi.org/10.1097/TP.0b013e3182184181
Askar, Medhat ; Schold, Jesse D. ; Eghtesad, Bijan ; Flechner, Stuart M. ; Kaplan, Bruce ; Klingman, Lynne ; Zein, Nizar N. ; Fung, John ; Srinivas, Titte R. / Combined liver-kidney transplants : Allosensitization and recipient outcomes. In: Transplantation. 2011 ; Vol. 91, No. 11. pp. 1286-1292.
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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.",
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AU - Kaplan, Bruce

AU - Klingman, Lynne

AU - Zein, Nizar N.

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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.

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