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Abstract

Aim Donor specific HLA antibodies (DSA) in liver transplant recipients have been associated with allograft dysfunction. This analysis aims to describe the clinical outcomes in simultaneous liver-kidney (SLK) recipients with and without HLA antibodies. Methods A retrospective review of 50 SLK recipients transplanted from 03/2010 to 03/2013 identified 31 patients with pre- and post-transplant HLA testing and donor HLA typing. HLA antibodies were monitored by Flow PRA and Luminex single antigen assays. Results The 31 SLK recipients evaluated were 58 ± 10 years old at transplant, had a MELD score of 38 ± 5, were primarily male (52%), Caucasian (68%), on dialysis (81%), and had liver disease due to hepatitis C and/or alcoholic cirrhosis (65%). Mean follow-up was 11 ± 8 mos. Sensitization and clinical outcomes are described in the figure. Flow crossmatch (FXM) was performed on pre-transplant sera in 14 patients. Two sensitized patients without a DSA evaluation had a negative FXM. In DSA+ patients, 11 of 12 FXM were positive. DSA became negative post-transplant in 54% of pre-transplant DSA+ patients. De novo DSA developed in 17% of unsensitized patients. Acute cellular (ACR) or antibody mediated rejection of the kidney were most common in sensitized patients, with the majority seen in DSA+ patients. Liver ACR was seen in 1 unsensitized and 1 DSA+ patient. Three deaths occurred in DSA+ patients.[Fig. 1] Conclusions DSA levels may decrease post-transplant in some patients; however, persistent DSA post-transplant increases likelihood of rejection. Further prospective analysis of DSA in SLK recipients will be important to determine the role of DSA in allograft survival. Download full-size image