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Successful Simultaneous Liver-Kidney Transplantation in the Presence of Multiple High-Titered Class I and II Antidonor HLA Antibodies
- Source :
- Transplantation Direct
- Publication Year :
- 2016
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2016.
-
Abstract
- The results of simultaneous liver-kidney transplants in highly sensitized recipients have been controversial in terms of antibody-mediated rejection and kidney allograft outcomes. This case report provides a detailed and sophisticated documentation of histocompatibility and pathologic data in a simultaneous liver-kidney transplant performed in a recipient with multiple high-titered class I and II antidonor HLA antibodies and a strongly positive cytotoxic crossmatch. Patient received induction with steroids, rituximab, and eculizumab without lymphocyte depleting agents. The kidney transplant was delayed by 6 hours after the liver transplant to allow more time to the liver allograft to “absorb” donor-specific antibodies (DSA). Interestingly, the liver allograft did not prevent immediate antibody-mediated injury to the kidney allograft in this highly sensitized recipient. Anti-HLA single antigen bead analysis of liver and kidney allograft biopsy eluates revealed deposition of both class I and II DSA in both liver and kidney transplants during the first 2 weeks after transplant. Afterward, both liver and kidney allograft functions improved and remained normal after a year with progressive reduction in serum DSA values.
- Subjects :
- Transplantation
Kidney
biology
business.industry
Lymphocyte
030232 urology & nephrology
030230 surgery
Eculizumab
Histocompatibility
03 medical and health sciences
surgical procedures, operative
0302 clinical medicine
medicine.anatomical_structure
Immunology
biology.protein
Medicine
Cytotoxic T cell
Rituximab
Case Study Reports
Antibody
business
medicine.drug
Subjects
Details
- ISSN :
- 23738731
- Volume :
- 2
- Database :
- OpenAIRE
- Journal :
- Transplantation Direct
- Accession number :
- edsair.doi.dedup.....d0641e556b0a3c7d1227760d70716c1e