Class II alloantibody and mortality in simultaneous liver-kidney transplantation

J. G. O'Leary, H. M. Gebel, R. Ruiz, R. A. Bray, J. D. Marr, X. J. Zhou, S. M. Shiller, B. M. Susskind, A. D. Kirk, G. B. Klintmalm

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Hyperacute kidney rejection is unusual in crossmatch positive recipients of simultaneous liver-kidney transplants (SLKT). However, recent data suggest that these patients remain at risk for antibody-mediated kidney rejection. To further investigate the risk associated with donor-specific alloantibodies (DSA) in SLKT, we studied 86 consecutive SLKT patients with an available pre-SLKT serum sample. Serum samples were analyzed in a blinded fashion for HLA DSA using single antigen beads (median florescence intensity ≥ 2,000 = positive). Post-SLKT samples were analyzed when available (76%). Thirty patients had preformed DSA, and nine developed de novo DSA. Preformed class I DSA did not change the risk of rejection, patient or allograft survival. In contrast, preformed class II DSA was associated with a markedly increased risk of renal antibody mediated rejection (AMR) (p = 0.006), liver allograft rejection (p = 0.002), patient death (p = 0.02), liver allograft loss (p = 0.02) and renal allograft loss (p = 0.045). Multivariable modeling showed class II DSA (preformed or de novo) to be an independent predictor of patient death (HR = 2.2; p = 0.043) and liver allograft loss (HR = 2.2; p = 0.044). These data warrant reconsideration of the approach to DSA in SLKT.

Original languageEnglish (US)
Pages (from-to)954-960
Number of pages7
JournalAmerican Journal of Transplantation
Volume13
Issue number4
DOIs
StatePublished - Apr 1 2013

Fingerprint

Isoantibodies
Liver Transplantation
Kidney Transplantation
Kidney
Mortality
Tissue Donors
Liver
Allografts
Transplants
Antibodies
Serum
Antigens

Keywords

  • Antibody-mediated rejection
  • donor-specific antibodies
  • graft outcomes
  • liver transplant
  • renal transplant
  • simultaneous liver-kidney transplant

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

Cite this

O'Leary, J. G., Gebel, H. M., Ruiz, R., Bray, R. A., Marr, J. D., Zhou, X. J., ... Klintmalm, G. B. (2013). Class II alloantibody and mortality in simultaneous liver-kidney transplantation. American Journal of Transplantation, 13(4), 954-960. https://doi.org/10.1111/ajt.12147

Class II alloantibody and mortality in simultaneous liver-kidney transplantation. / O'Leary, J. G.; Gebel, H. M.; Ruiz, R.; Bray, R. A.; Marr, J. D.; Zhou, X. J.; Shiller, S. M.; Susskind, B. M.; Kirk, A. D.; Klintmalm, G. B.

In: American Journal of Transplantation, Vol. 13, No. 4, 01.04.2013, p. 954-960.

Research output: Contribution to journalArticle

O'Leary, JG, Gebel, HM, Ruiz, R, Bray, RA, Marr, JD, Zhou, XJ, Shiller, SM, Susskind, BM, Kirk, AD & Klintmalm, GB 2013, 'Class II alloantibody and mortality in simultaneous liver-kidney transplantation', American Journal of Transplantation, vol. 13, no. 4, pp. 954-960. https://doi.org/10.1111/ajt.12147
O'Leary, J. G. ; Gebel, H. M. ; Ruiz, R. ; Bray, R. A. ; Marr, J. D. ; Zhou, X. J. ; Shiller, S. M. ; Susskind, B. M. ; Kirk, A. D. ; Klintmalm, G. B. / Class II alloantibody and mortality in simultaneous liver-kidney transplantation. In: American Journal of Transplantation. 2013 ; Vol. 13, No. 4. pp. 954-960.
@article{10f360eb89154b48bf1fef53c6b2c9ce,
title = "Class II alloantibody and mortality in simultaneous liver-kidney transplantation",
abstract = "Hyperacute kidney rejection is unusual in crossmatch positive recipients of simultaneous liver-kidney transplants (SLKT). However, recent data suggest that these patients remain at risk for antibody-mediated kidney rejection. To further investigate the risk associated with donor-specific alloantibodies (DSA) in SLKT, we studied 86 consecutive SLKT patients with an available pre-SLKT serum sample. Serum samples were analyzed in a blinded fashion for HLA DSA using single antigen beads (median florescence intensity ≥ 2,000 = positive). Post-SLKT samples were analyzed when available (76{\%}). Thirty patients had preformed DSA, and nine developed de novo DSA. Preformed class I DSA did not change the risk of rejection, patient or allograft survival. In contrast, preformed class II DSA was associated with a markedly increased risk of renal antibody mediated rejection (AMR) (p = 0.006), liver allograft rejection (p = 0.002), patient death (p = 0.02), liver allograft loss (p = 0.02) and renal allograft loss (p = 0.045). Multivariable modeling showed class II DSA (preformed or de novo) to be an independent predictor of patient death (HR = 2.2; p = 0.043) and liver allograft loss (HR = 2.2; p = 0.044). These data warrant reconsideration of the approach to DSA in SLKT.",
keywords = "Antibody-mediated rejection, donor-specific antibodies, graft outcomes, liver transplant, renal transplant, simultaneous liver-kidney transplant",
author = "O'Leary, {J. G.} and Gebel, {H. M.} and R. Ruiz and Bray, {R. A.} and Marr, {J. D.} and Zhou, {X. J.} and Shiller, {S. M.} and Susskind, {B. M.} and Kirk, {A. D.} and Klintmalm, {G. B.}",
year = "2013",
month = "4",
day = "1",
doi = "10.1111/ajt.12147",
language = "English (US)",
volume = "13",
pages = "954--960",
journal = "American Journal of Transplantation",
issn = "1600-6135",
publisher = "Wiley-Blackwell",
number = "4",

}

TY - JOUR

T1 - Class II alloantibody and mortality in simultaneous liver-kidney transplantation

AU - O'Leary, J. G.

AU - Gebel, H. M.

AU - Ruiz, R.

AU - Bray, R. A.

AU - Marr, J. D.

AU - Zhou, X. J.

AU - Shiller, S. M.

AU - Susskind, B. M.

AU - Kirk, A. D.

AU - Klintmalm, G. B.

PY - 2013/4/1

Y1 - 2013/4/1

N2 - Hyperacute kidney rejection is unusual in crossmatch positive recipients of simultaneous liver-kidney transplants (SLKT). However, recent data suggest that these patients remain at risk for antibody-mediated kidney rejection. To further investigate the risk associated with donor-specific alloantibodies (DSA) in SLKT, we studied 86 consecutive SLKT patients with an available pre-SLKT serum sample. Serum samples were analyzed in a blinded fashion for HLA DSA using single antigen beads (median florescence intensity ≥ 2,000 = positive). Post-SLKT samples were analyzed when available (76%). Thirty patients had preformed DSA, and nine developed de novo DSA. Preformed class I DSA did not change the risk of rejection, patient or allograft survival. In contrast, preformed class II DSA was associated with a markedly increased risk of renal antibody mediated rejection (AMR) (p = 0.006), liver allograft rejection (p = 0.002), patient death (p = 0.02), liver allograft loss (p = 0.02) and renal allograft loss (p = 0.045). Multivariable modeling showed class II DSA (preformed or de novo) to be an independent predictor of patient death (HR = 2.2; p = 0.043) and liver allograft loss (HR = 2.2; p = 0.044). These data warrant reconsideration of the approach to DSA in SLKT.

AB - Hyperacute kidney rejection is unusual in crossmatch positive recipients of simultaneous liver-kidney transplants (SLKT). However, recent data suggest that these patients remain at risk for antibody-mediated kidney rejection. To further investigate the risk associated with donor-specific alloantibodies (DSA) in SLKT, we studied 86 consecutive SLKT patients with an available pre-SLKT serum sample. Serum samples were analyzed in a blinded fashion for HLA DSA using single antigen beads (median florescence intensity ≥ 2,000 = positive). Post-SLKT samples were analyzed when available (76%). Thirty patients had preformed DSA, and nine developed de novo DSA. Preformed class I DSA did not change the risk of rejection, patient or allograft survival. In contrast, preformed class II DSA was associated with a markedly increased risk of renal antibody mediated rejection (AMR) (p = 0.006), liver allograft rejection (p = 0.002), patient death (p = 0.02), liver allograft loss (p = 0.02) and renal allograft loss (p = 0.045). Multivariable modeling showed class II DSA (preformed or de novo) to be an independent predictor of patient death (HR = 2.2; p = 0.043) and liver allograft loss (HR = 2.2; p = 0.044). These data warrant reconsideration of the approach to DSA in SLKT.

KW - Antibody-mediated rejection

KW - donor-specific antibodies

KW - graft outcomes

KW - liver transplant

KW - renal transplant

KW - simultaneous liver-kidney transplant

UR - http://www.scopus.com/inward/record.url?scp=84875727347&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84875727347&partnerID=8YFLogxK

U2 - 10.1111/ajt.12147

DO - 10.1111/ajt.12147

M3 - Article

C2 - 23433356

AN - SCOPUS:84875727347

VL - 13

SP - 954

EP - 960

JO - American Journal of Transplantation

JF - American Journal of Transplantation

SN - 1600-6135

IS - 4

ER -