Corresponding author: Rolf N. Barth, MD, Division of Transplantation, University of Maryland School of Medicine, 29 S. Greene Street, Suite 200, Baltimore, MD 21201, USA.
Tel.: 410 328 5408; fax: 410 328 6343;
e-mail: [email protected]

No financial support was provided to conduct this work.

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Abstract

Barth RN, Campos L, Kukuruga DL, Drachenberg C, Philosophe B. Antibody-mediated rejection of renal allograft in combined liver–kidney transplant.
Clin Transplant 2009 DOI: 10.1111/j.1399-0012.2009.01161.x
© 2009 John Wiley & Sons A/S.

Abstract: Liver transplantation is performed based on ABO blood type compatibility without dependence on crossmatch results. Combined liver–kidney transplantation (CLKT) is similarly performed without dependence of crossmatch results as the liver is thought to confer protection to the renal allograft against alloantibody. We report a case of CLKT in a sensitized patient with antibody-mediated rejection (AMR) of the renal allograft. AMR was confirmed with C4d staining and serial monitoring of donor-specific antibody (DSA). Despite intensive therapy directed against AMR and the presence of the liver allograft, the patient demonstrated increasing titers of alloantibody, never demonstrated adequate renal function, and ultimately expired after two months. This result demonstrates the potential for AMR of the renal allograft in sensitized recipients of CLKT.

References

1 Neumann UP, Lang M, Moldenhauer A et al. Significance of a T-lymphocytotoxic crossmatch in liver and combined liver-kidney transplantation. Transplantation 2001: 71: 1163.
10.1097/00007890-200104270-00025
CAS PubMed Web of Science® Google Scholar
2 Watson R, Kozlowski T, Nickeleit V et al. Isolated donor specific alloantibody-mediated rejection after ABO compatible liver transplantation. Am J Transplant 2006: 6: 3022.
10.1111/j.1600-6143.2006.01554.x
CAS PubMed Web of Science® Google Scholar
3 Katznelson S, Cecka JM. The liver neither protects the kidney from rejection nor improves kidney graft survival after combined liver and kidney transplantation from the same donor. Transplantation 1996: 61: 1403.
10.1097/00007890-199605150-00021
CAS PubMed Web of Science® Google Scholar
4 Saidman SL, Duquesnoy RJ, Demetris AJ et al. Combined liver-kidney transplantation and the effect of preformed lymphocytotoxic antibodies. Transpl Immunol 1994: 2: 61.
10.1016/0966-3274(94)90080-9
CAS PubMed Google Scholar
5 Fong TL, Bunnapradist S, Jordan SC, Selby RR, Cho YW. Analysis of the United Network for Organ Sharing database comparing renal allografts and patient survival in combined liver-kidney transplantation with the contralateral allografts in kidney alone or kidney-pancreas transplantation. Transplantation 2003: 76: 348.
10.1097/01.TP.0000071204.03720.BB
PubMed Web of Science® Google Scholar
6 Simpson N, Cho YW, Cicciarelli JC, Selby RR, Fong TL. Comparison of renal allograft outcomes in combined liver-kidney transplantation versus subsequent kidney transplantation in liver transplant recipients: analysis of UNOS Database. Transplantation 2006: 82: 1298.
10.1097/01.tp.0000241104.58576.e6
PubMed Web of Science® Google Scholar
7 Morrissey PE, Gordon F, Shaffer D et al. Combined liver-kidney transplantation in patients with cirrhosis and renal failure: effect of a positive cross-match and benefits of combined transplantation. Liver Transpl Surg 1998: 4: 363.
10.1002/lt.500040512
CAS PubMed Web of Science® Google Scholar
8 Faenza A, Fuga G, Nardo B et al. Combined liver-kidney transplantation: the experience of the University of Bologna and the case of preoperative positive cross-match. Transplant Proc 2006: 38: 1118.
10.1016/j.transproceed.2006.03.048
PubMed Web of Science® Google Scholar
9 Mosconi G, Scolari MP, Feliciangeli G et al. Combined liver-kidney transplantation with preformed anti-HLA antibodies: a case report. Transplant Proc 2006: 38: 1125.
10.1016/j.transproceed.2006.03.045
CAS PubMed Web of Science® Google Scholar
10 Creput C, Durrbach A, Samuel D et al. Incidence of renal and liver rejection and patient survival rate following combined liver and kidney transplantation. Am J Transplant 2003: 3: 348.
10.1034/j.1600-6143.2003.00050.x
CAS PubMed Web of Science® Google Scholar
11 Ruiz R, Kunitake H, Wilkinson AH et al. Long-term analysis of combined liver and kidney transplantation at a single center. Arch Surg 2006: 141: 735.
10.1001/archsurg.141.8.735
PubMed Web of Science® Google Scholar
12 McAlister CC, Gao ZH, McAlister VC et al. Protective anti-donor IgM production after crossmatch positive liver–kidney transplantation. Liver Transpl 2004: 10: 315.
10.1002/lt.20062
PubMed Web of Science® Google Scholar
13 Olausson M, Mjornstedt L, Norden G et al. Successful combined partial auxiliary liver and kidney transplantation in highly sensitized cross-match positive recipients. Am J Transplant 2007: 7: 130.
10.1111/j.1600-6143.2006.01592.x
CAS PubMed Web of Science® Google Scholar
14 Bellamy CO, Herriot MM, Harrison DJ, Bathgate AJ. C4d immunopositivity is uncommon in ABO-compatible liver allografts, but correlates partially with lymphocytotoxic antibody status. Histopathology 2007: 50: 739.
10.1111/j.1365-2559.2007.02677.x
PubMed Web of Science® Google Scholar
15 Wade JA, Hurley CK, Takemoto SK et al. HLA mismatching within or outside of cross-reactive groups (CREGs) is associated with similar outcomes after unrelated hematopoietic stem cell transplantation. Blood 2007: 109: 4064.
10.1182/blood-2006-06-032193
CAS PubMed Web of Science® Google Scholar
16 Laux G, Opelz G. Immunological relevance of CREG matching in cadaver kidney transplantation. Transplantation 2004: 78: 442.
10.1097/01.TP.0000128615.41964.BC
PubMed Web of Science® Google Scholar
17 Stobbe I, Van Der Meer-Prins EM, De Lange P et al. Cross-reactive group matching does not lead to a better allocation and survival of donor kidneys. Transplantation 2000: 70: 157.
PubMed Web of Science® Google Scholar

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Volume24, Issue5

September/October 2010

Pages 685-690

Antibody-mediated rejection of renal allograft in combined liver–kidney transplant

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Antibody-mediated rejection of renal allograft in combined liver–kidney transplant

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