Combined Liver-Kidney Transplantation With Preformed Anti-human Leukocyte Antigen Donor-Specific Antibodies

Introduction: the impact of preformed donor-specific anti-human leukocyte antigen (HLA) antibodies (pDSAs) after combined liver-kidney transplantation (CLKT) is still uncertain. Methods: we conducted a retrospective study in 8 European high-volume transplant centers and investigated the outcome of 1...

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Authors: Bello, Amaud del, Thaunat, Olivier, Quintrec, Moglie le, Bestard Matamoros, Oriol, Durrbach, Antoine, Perrin, Peggy, Gatault, Philippe, Jambon, Frederic, Pageaux, Georges-Philippe, Lladó Garriga, Laura, Besch, Camille, Barbier, Louise, Neau-Cransac, Martine, Dumortier, Jérôme, Kamar, Nassim
Format: article
Status:Published version
Publication Date:2020
Country:España
Institution:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repository:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:2445/177754
Online Access:https://hdl.handle.net/2445/177754
Access Level:Open access
Keyword:Trasplantament d'òrgans
Fetge
Ronyó
Rebuig (Biologia)
Transplantation of organs
Liver
Kidney
Graft rejection
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spelling Combined Liver-Kidney Transplantation With Preformed Anti-human Leukocyte Antigen Donor-Specific AntibodiesBello, Amaud delThaunat, OlivierQuintrec, Moglie leBestard Matamoros, OriolDurrbach, AntoinePerrin, PeggyGatault, PhilippeJambon, FredericPageaux, Georges-PhilippeLladó Garriga, LauraBesch, CamilleBarbier, LouiseNeau-Cransac, MartineDumortier, JérômeKamar, NassimTrasplantament d'òrgansFetgeRonyóRebuig (Biologia)Transplantation of organsLiverKidneyGraft rejectionIntroduction: the impact of preformed donor-specific anti-human leukocyte antigen (HLA) antibodies (pDSAs) after combined liver-kidney transplantation (CLKT) is still uncertain. Methods: we conducted a retrospective study in 8 European high-volume transplant centers and investigated the outcome of 166 consecutive CLKTs, including 46 patients with pDSAs. Results: patient survival was lower in those with pDSAs (5-year patient survival rate of 63% and 78% with or without pDSA, respectively; P = 0.04). The presence of pDSAs with a mean fluorescence intensity (MFI) ≥ 5000 (hazard ratio 4.96; 95% confidence interval: 2.3-10.9; P < 0.001) and the presence of 3 or more pDSAs (hazard ratio 6.5; 95% confidence interval: 2.5-18.8; P = 0.05) were independently associated with death. The death-censored liver graft survival was similar in patients with or without pDSAs. Kidney graft survival was comparable in both groups. (The 1- and 5-year death-censored graft survival rates were 91.6% and 79.5%, respectively, in patients with pDSAs and 93% and 88%, respectively, in the donor-specific antibody [DSA]-negative group, P = not significant). Despite a higher rate of kidney graft rejection in patients with pDSAs (5-year kidney graft survival rate without rejection of 87% and 97% with or without pDSAs, respectively; P = 0.04), kidney function did not statistically differ between both groups at 5 years post-transplantation (estimated glomerular filtration rate 45 ± 17 vs. 57 ± 29 ml/min per 1.73 m2, respectively, in patients with and without pDSAs). Five recipients with pDSAs (11.0%) experienced an antibody-mediated kidney rejection that led to graft loss in 1 patient. Conclusion: our results suggest that CLKT with pDSAs is associated with a lower patients' survival despite good recipients', liver and kidney grafts' outcome.Elsevier2021202120202021info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion10 p.application/pdfhttps://hdl.handle.net/2445/177754Articles publicats en revistes (Ciències Clíniques)reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)InglésReproducció del document publicat a: https://doi.org/10.1016/j.ekir.2020.09.018Kidney International Reports, 2020, vol. 5, num. 12, p. 2202-2211https://doi.org/10.1016/j.ekir.2020.09.018cc-by-nc-nd (c) International Society of Nephrology, 2020https://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessoai:recercat.cat:2445/1777542026-05-29T05:05:01Z
dc.title.none.fl_str_mv Combined Liver-Kidney Transplantation With Preformed Anti-human Leukocyte Antigen Donor-Specific Antibodies
title Combined Liver-Kidney Transplantation With Preformed Anti-human Leukocyte Antigen Donor-Specific Antibodies
spellingShingle Combined Liver-Kidney Transplantation With Preformed Anti-human Leukocyte Antigen Donor-Specific Antibodies
Bello, Amaud del
Trasplantament d'òrgans
Fetge
Ronyó
Rebuig (Biologia)
Transplantation of organs
Liver
Kidney
Graft rejection
title_short Combined Liver-Kidney Transplantation With Preformed Anti-human Leukocyte Antigen Donor-Specific Antibodies
title_full Combined Liver-Kidney Transplantation With Preformed Anti-human Leukocyte Antigen Donor-Specific Antibodies
title_fullStr Combined Liver-Kidney Transplantation With Preformed Anti-human Leukocyte Antigen Donor-Specific Antibodies
title_full_unstemmed Combined Liver-Kidney Transplantation With Preformed Anti-human Leukocyte Antigen Donor-Specific Antibodies
title_sort Combined Liver-Kidney Transplantation With Preformed Anti-human Leukocyte Antigen Donor-Specific Antibodies
dc.creator.none.fl_str_mv Bello, Amaud del
Thaunat, Olivier
Quintrec, Moglie le
Bestard Matamoros, Oriol
Durrbach, Antoine
Perrin, Peggy
Gatault, Philippe
Jambon, Frederic
Pageaux, Georges-Philippe
Lladó Garriga, Laura
Besch, Camille
Barbier, Louise
Neau-Cransac, Martine
Dumortier, Jérôme
Kamar, Nassim
author Bello, Amaud del
author_facet Bello, Amaud del
Thaunat, Olivier
Quintrec, Moglie le
Bestard Matamoros, Oriol
Durrbach, Antoine
Perrin, Peggy
Gatault, Philippe
Jambon, Frederic
Pageaux, Georges-Philippe
Lladó Garriga, Laura
Besch, Camille
Barbier, Louise
Neau-Cransac, Martine
Dumortier, Jérôme
Kamar, Nassim
author_role author
author2 Thaunat, Olivier
Quintrec, Moglie le
Bestard Matamoros, Oriol
Durrbach, Antoine
Perrin, Peggy
Gatault, Philippe
Jambon, Frederic
Pageaux, Georges-Philippe
Lladó Garriga, Laura
Besch, Camille
Barbier, Louise
Neau-Cransac, Martine
Dumortier, Jérôme
Kamar, Nassim
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Trasplantament d'òrgans
Fetge
Ronyó
Rebuig (Biologia)
Transplantation of organs
Liver
Kidney
Graft rejection
topic Trasplantament d'òrgans
Fetge
Ronyó
Rebuig (Biologia)
Transplantation of organs
Liver
Kidney
Graft rejection
description Introduction: the impact of preformed donor-specific anti-human leukocyte antigen (HLA) antibodies (pDSAs) after combined liver-kidney transplantation (CLKT) is still uncertain. Methods: we conducted a retrospective study in 8 European high-volume transplant centers and investigated the outcome of 166 consecutive CLKTs, including 46 patients with pDSAs. Results: patient survival was lower in those with pDSAs (5-year patient survival rate of 63% and 78% with or without pDSA, respectively; P = 0.04). The presence of pDSAs with a mean fluorescence intensity (MFI) ≥ 5000 (hazard ratio 4.96; 95% confidence interval: 2.3-10.9; P < 0.001) and the presence of 3 or more pDSAs (hazard ratio 6.5; 95% confidence interval: 2.5-18.8; P = 0.05) were independently associated with death. The death-censored liver graft survival was similar in patients with or without pDSAs. Kidney graft survival was comparable in both groups. (The 1- and 5-year death-censored graft survival rates were 91.6% and 79.5%, respectively, in patients with pDSAs and 93% and 88%, respectively, in the donor-specific antibody [DSA]-negative group, P = not significant). Despite a higher rate of kidney graft rejection in patients with pDSAs (5-year kidney graft survival rate without rejection of 87% and 97% with or without pDSAs, respectively; P = 0.04), kidney function did not statistically differ between both groups at 5 years post-transplantation (estimated glomerular filtration rate 45 ± 17 vs. 57 ± 29 ml/min per 1.73 m2, respectively, in patients with and without pDSAs). Five recipients with pDSAs (11.0%) experienced an antibody-mediated kidney rejection that led to graft loss in 1 patient. Conclusion: our results suggest that CLKT with pDSAs is associated with a lower patients' survival despite good recipients', liver and kidney grafts' outcome.
publishDate 2020
dc.date.none.fl_str_mv 2020
2021
2021
2021
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/177754
url https://hdl.handle.net/2445/177754
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.1016/j.ekir.2020.09.018
Kidney International Reports, 2020, vol. 5, num. 12, p. 2202-2211
https://doi.org/10.1016/j.ekir.2020.09.018
dc.rights.none.fl_str_mv cc-by-nc-nd (c) International Society of Nephrology, 2020
https://creativecommons.org/licenses/by-nc-nd/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc-by-nc-nd (c) International Society of Nephrology, 2020
https://creativecommons.org/licenses/by-nc-nd/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 10 p.
application/pdf
dc.publisher.none.fl_str_mv Elsevier
publisher.none.fl_str_mv Elsevier
dc.source.none.fl_str_mv Articles publicats en revistes (Ciències Clíniques)
reponame:Recercat. Dipósit de la Recerca de Catalunya
instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
reponame_str Recercat. Dipósit de la Recerca de Catalunya
collection Recercat. Dipósit de la Recerca de Catalunya
repository.name.fl_str_mv
repository.mail.fl_str_mv
_version_ 1869407228873670656
score 15,812429

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