Effect of Pre-Transplant Sensitization on Kidney Allograft Survival Following Simultaneous Liver and Kidney Transplantation: A Decade of Experience from an Academic Transplant Center.
Andrew D Santeusanio, Fahima Mahir, Matias Facciuto, Ron Shapiro, Veronica Delaney, Thomas Schiano, Jang Moon, Sander Florman, Leona Kim-Schluger, Fasika Tedla, Arjun Bhansali
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Abstract
Background: There are conflicting data regarding the impact of pre-transplant sensitization on kidney allograft outcomes following simultaneous liver-kidney (SLK) transplantation.
Methods: This was a single-center, retrospective study of adult SLK transplant recipients during the decade from 2010 to 2020. Patients were classified based on complement dependent cytotoxicity crossmatching (CDC-CXM) as well as the presence of donor specific antibodies (DSA) and followed until study conclusion on January 1, 2021. Cox-proportional hazards modeling was performed to identify clinical variables associated with combined patient and allograft survival as well as biopsy proven kidney rejection (BPAR).
Results: A total of 90 patients were included in the study (16 positive CDC-CXM and 31 with DSA). Overall patient and allograft survival was 91.1% at 1-year and 68.9% at study conclusion after a median of 4.4 years, with corresponding death-censored kidney survival of 98.8% and 91.2%. In the multivariable analysis, a positive CDC-CXM (HR = 3.79; 95% CI 1.70-8.46) but not pre-formed DSA was associated with patient and graft loss. BPAR occurred in 12 patients (13.3%) and was higher among patients with DSA >5,000 (HR = 3.69; 95% CI 1.14-11.98), although this did not impact overall kidney survival. DSA cleared in 85% of patients following SLK transplant but persisted in three patients with DQ-specific antibodies.
Conclusions: A positive CDC-CXM but not the presence of pre-formed DSA was associated with worse outcomes following SLK transplantation, with overall kidney survival primarily driven by death with a functioning allograft. DSA >5,000 MFI increased the risk for BPAR, and DSA to the class II DQ antigen were incompletely cleared following SLK transplant; however, overall kidney survival was not impacted.
期刊介绍：
Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored.
Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include:
Immunology and immunosuppression;
Patient preparation;
Social, ethical, and psychological issues;
Complications, short- and long-term results;
Artificial organs;
Donation and preservation of organ and tissue;
Translational studies;
Advances in tissue typing;
Updates on transplant pathology;.
Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries.
Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.
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