Donor-directed MHC class I antibody is preferentially cleared from sensitized recipients of combined liver/kidney transplants

Am J Transplant. 2011 Apr;11(4):841-7. doi: 10.1111/j.1600-6143.2011.03467.x.

Abstract

For patients with chronic renal and liver diseases, simultaneous liver and kidney transplantation (SLKT) is the best therapeutic option. The role of a pretransplant donor-specific antibody (DSA) in SLKT is unclear. We report the results of a retrospective review from 7/08 to 10/09 of SLKT at our institution. Monitoring of DSA was performed using single antigen bead assay. Between 7/08 and 10/09, there were six SLKT who had preformed DSA and positive XM (four class I and II DSA, one class I DSA only, one class II only). One-year patient and renal graft survival was 83%. Death-censored liver allograft survival was 100%. Acute humoral rejection (AHR) of the kidney occurred in 66% (three with both class I and II DSA and one with only class II DSA) of patients. In those with AHR, class I antibodies were rapidly cleared (p < 0.01) while class II antibodies persisted (p = 0.25). All patients who had humoral rejection of their kidney had preformed anticlass II antibodies. Liver allografts may not be fully protective of the renal allograft, especially with pre-existing MHC class II DSA. Long-term and careful follow-up will be critical to determine the impact of DSA on both allografts.

MeSH terms

  • Antibody Specificity
  • Genes, MHC Class I / immunology*
  • Genes, MHC Class II / immunology*
  • Graft Rejection / immunology*
  • Graft Survival
  • Histocompatibility Testing
  • Humans
  • Isoantibodies / immunology*
  • Kidney Transplantation / immunology*
  • Liver Transplantation / immunology*
  • Retrospective Studies
  • Tissue Donors*
  • Transplantation, Homologous

Substances

  • Isoantibodies