Abstract
Background De novo Donor Specific Antibodies (DSA) are considered as a risk factor for the kidney allograft outcomes in recipients after simultaneous liver–kidney transplantation (SLKT). We hypothesized that length of hospital stay (LOS) might be associated with de novo DSA development of due to the increased likelihood of receiving blood transfusions with reduced immunosuppressive regimens. Methods This study is a single-center, retrospective cohort study consisting of 85 recipients who underwent SLKT from 2009 to 2018 in our hospital. We divided the patients into two groups according to LOS [long hospital stay (L) group (LOS >14 days) and short hospital stay (S) group (LOS ≤14 days)]. Propensity score (PS) has been created using logistic regression to predict LOS greater than median of 14 days. The association between the presence of de novo DSA and LOS was assessed by logistic regression models adjusted for PS. Results The mean age at transplantation of the entire cohort was 55.5 ± 10.1 years. Sixty percent of the recipients were male and Caucasian. Median LOS in (L) group was three-fold longer than (S) group [L: median 30 days (IQR: 21–52), S: median 8.5 days (IQR: 7–11)]. Eight patients developed de novo DSA after SLKT (9.4%), all of them were in (L) group. Longer LOS was significantly associated with higher risk of development of de novo DSA in unadjusted (OR+ each 5 days: 1.09, 95% CI:1.02–1.16) and PS adjusted (OR+ each 5 days: 1.11, 95% CI:1.02–1.21) analysis. Conclusion Longer hospitalization is significantly associated with the development of de novo DSA in SLKT.
Highlights
Post-transplant donor-specific antibodies (DSA), either identified pre-transplant or newly developed beyond the absorptive capacity conferred by allograft liver [1–4], present a risk factor for patient- and allograft kidney outcome after simultaneous liver–kidney transplantation (SLKT) [5,6]
Retrospective study, we found significant associations between longer hospitalization and higher probability of both persistent post-transplant Donor Specific Antibodies (DSA) and de novo DSA development after SLKT
Our study indicates that longer length of hospital stay (LOS) occurred more frequently in SLKT patients with higher Model for End-stage Liver Disease (MELD) scores and higher incidence of delayed allograft kidney function (DGF) in allograft kidney
Summary
Post-transplant donor-specific antibodies (DSA), either identified pre-transplant (persistent DSA) or newly developed (de novo DSA) beyond the absorptive capacity conferred by allograft liver [1–4], present a risk factor for patient- and allograft kidney outcome after simultaneous liver–kidney transplantation (SLKT) [5,6]. The risk factors associated with newly developed de novo DSA have not been well investigated in SLKT. De novo Donor Specific Antibodies (DSA) are considered as a risk factor for the kidney allograft outcomes in recipients after simultaneous liver–kidney transplantation (SLKT). Longer LOS was significantly associated with higher risk of development of de novo DSA in unadjusted (ORþ each 5 days: 1.09, 95% CI:1.02–1.16) and PS adjusted (ORþ each 5 days: 1.11, 95% CI:1.02–1.21) analysis. Conclusion: Longer hospitalization is significantly associated with the development of de novo DSA in SLKT
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