1
|
Riad S, Aby ES, Nguyen PL, Jackson S, Lim N, Lake J. Long-term outcomes of crossmatch positive simultaneous liver-kidney transplantations in the United States. Liver Transpl 2022; 28:1509-1520. [PMID: 35182001 DOI: 10.1002/lt.26433] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/27/2022] [Accepted: 02/08/2022] [Indexed: 01/13/2023]
Abstract
The long-term outcomes of positive crossmatch (+XM) simultaneous liver-kidney (SLK) transplantations are conflicting. We examined the association between crossmatch status and SLK outcomes in recipients discharged on tacrolimus and mycophenolate with or without steroids. We analyzed the Scientific Registry of Transplant Recipients for all primary SLK recipients between 2003 and 2020 with available crossmatch and induction data. We grouped recipients according to the crossmatch status: negative crossmatch (-XM; n = 3040) and +XM (n = 407). Kaplan-Meier curves were generated to examine recipient, death-censored liver, and death-censored kidney survival by crossmatch status. Cox proportional hazard models were used to investigate the association between crossmatch status and outcomes of interest with follow-up censored at 10 years. Models were adjusted for recipient age, sex, diabetes mellitus, Model for End-Stage Liver Disease score, duration on the liver waiting list, induction immunosuppression, steroid maintenance, hepatitis C infection, donor age and sex, local vs. shared organ, cold ischemia time, and previous liver transplantation status. In the univariable analysis, crossmatch status was not associated with recipient survival (log-rank p = 0.63), death-censored liver graft survival (log-rank p = 0.05), or death-censored kidney graft survival (log-rank p = 0.11). Compared with -XM, +XM recipients had a similar 1-year liver rejection rate, but higher kidney rejection rate (4.6% vs. 8.9%, p = 0.002). In the multivariable models, +XM status was not associated with deleterious long-term recipient, liver, or kidney grafts survival. -XM and +XM SLK transplantations have comparable long-term recipient, liver graft, and kidney survival with a slightly increased risk of early kidney allograft rejection in the +XM group. Crossmatch positivity in SLK transplantations should not influence the decision to use organs from a specific donor.
Collapse
Affiliation(s)
- Samy Riad
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Elizabeth S Aby
- Division of Gastroenterology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Phuoc Le Nguyen
- Division of Transplant Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Scott Jackson
- Complex Care Analytics, MHealth Fairview, Minneapolis, Minnesota, USA
| | - Nicholas Lim
- Division of Gastroenterology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - John Lake
- Division of Gastroenterology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|
2
|
Dekeyser M, Taupin JL, Elias M, Ichaï P, Herr F, Boudon M, Brunel M, Sa cunha A, Coilly A, Saliba F, Durrbach A. Impact of DSA and immunosuppression minimization on rejection, graft, and patient survival after simultaneous liver–kidney transplantation. Front Med (Lausanne) 2022; 9:949833. [PMID: 36072942 PMCID: PMC9441637 DOI: 10.3389/fmed.2022.949833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 07/20/2022] [Indexed: 11/16/2022] Open
Abstract
Background Acute rejection rate is low after simultaneous liver–kidney transplantation (SLKT), leading some groups to minimize immunosuppressive (IS) regimens. However, the impact of preformed (pDSA) or de novo donor-specific antibodies (dnDSA) on the graft remains unclear. Methods We performed a retrospective analysis of 102 consecutive SLKT patients to study the impact of anti-HLA antibodies. Results Anti-HLA antibodies were detected in 75 recipients (class I 23.8%, both classes I and II 23.8%, and class II 14.3%). In total, 42.8% of the patients had pDSA and 21.7% developed dnDSA. Overall patient survival at 1–3 and 5 years, was respectively 88, 84, and 80%. Acute rejection occurred respectively in 3 (2.9%) liver and 6 kidney (5.9%) recipients. pDSA with titers over 10,000 mean fluorescence intensity (14.3%) was associated with lower patient survival (40 vs. 82%) but not with acute rejection. In a multivariable Cox regression analysis, the risk of death was associated with maleness, the highest titer of pDSA (p < 0.0007) or the sum of pDSA >10,000. Renal function did not differ between patients with class I pDSA (p = 0.631) and those with class II pDSA (p = 0.112) or between patients with and without a positive cross-match (p = 0.842). dnDSA were not associated with acute rejection, graft dysfunction or patient survival. IS minimization was not associated with rejection, graft dysfunction or death. Conclusion In SLKT, high levels of pDSA >10,000 were associated with lower patient survival, but not rejection or graft survival. Minimization of maintenance immunosuppression regimen was not associated with a poorer outcome.
Collapse
Affiliation(s)
- Manon Dekeyser
- Nephrology and Transplantation Department, APHP, Henri Mondor Hospital, Créteil, France
- INSERM UMR 1186, Institut Gustave Roussy, Villejuif, France
- Paris-Saclay University, Paris, France
| | - Jean-Luc Taupin
- HLA Laboratory, AP-HP Saint Louis Hospital, Paris, France
- University of Paris, Paris, France
| | - Michelle Elias
- Nephrology and Transplantation Department, APHP, Henri Mondor Hospital, Créteil, France
| | - Philippe Ichaï
- APHP, Paul Brousse Hospital, INSERM UMR 1193, Villejuif, France
| | - Florence Herr
- INSERM UMR 1186, Institut Gustave Roussy, Villejuif, France
- Paris-Saclay University, Paris, France
| | - Marc Boudon
- APHP, Paul Brousse Hospital, INSERM UMR 1193, Villejuif, France
| | - Melanie Brunel
- Nephrology and Transplantation Department, APHP, Henri Mondor Hospital, Créteil, France
- INSERM UMR 1186, Institut Gustave Roussy, Villejuif, France
- Paris-Saclay University, Paris, France
| | - Antonio Sa cunha
- Paris-Saclay University, Paris, France
- APHP, Paul Brousse Hospital, INSERM UMR 1193, Villejuif, France
| | - Audrey Coilly
- Paris-Saclay University, Paris, France
- APHP, Paul Brousse Hospital, INSERM UMR 1193, Villejuif, France
| | - Faouzi Saliba
- Paris-Saclay University, Paris, France
- APHP, Paul Brousse Hospital, INSERM UMR 1193, Villejuif, France
| | - Antoine Durrbach
- Nephrology and Transplantation Department, APHP, Henri Mondor Hospital, Créteil, France
- INSERM UMR 1186, Institut Gustave Roussy, Villejuif, France
- Paris-Saclay University, Paris, France
- *Correspondence: Antoine Durrbach,
| |
Collapse
|
3
|
Del Bello A, Thaunat O, Le Quintrec M, Bestard O, Durrbach A, Perrin P, Gatault P, Jambon F, Pageaux GP, Llado L, Besch C, Barbier L, Neau-Cransac M, Dumortier J, Kamar N. Combined Liver-Kidney Transplantation With Preformed Anti-human Leukocyte Antigen Donor-Specific Antibodies. Kidney Int Rep 2020; 5:2202-2211. [PMID: 33305113 PMCID: PMC7710847 DOI: 10.1016/j.ekir.2020.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 08/09/2020] [Accepted: 09/08/2020] [Indexed: 02/07/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Arnaud Del Bello
- Department of Nephrology and Organ Transplantation, Toulouse University Hospital (Centre Hospitalier et Universitaire), Toulouse, France.,Faculty of Medicine, Paul Sabatier University, Toulouse, France.,Toulouse Purpan Physiopathology Center, French National Institute of Health and Medical Research (INSERM) Unité Mixte de Recherche 1043, Toulouse, France
| | - Olivier Thaunat
- Hospices Civils de Lyon, Department of Transplantation, Nephrology and Clinical Immunology, Edouard Herriot Hospital, Lyon, France.,INSERM Unit 1111, Lyon, France.,Lyon-Est Faculty of Medicine, Claude Bernard University, Lyon, France
| | - Moglie Le Quintrec
- Department of Nephrology, Montpellier University Hospital, Montpellier, France.,INSERM U1183, Institute for Regenerative Medicine and Biotherapy, Saint-Eloi Hospital, Montpellier University Hospital, Montpellier, France
| | - Oriol Bestard
- Nephrology Department, Kidney Transplant Unit, Bellvitge University Hospital, Barcelona, Spain.,Experimental Nephrology Laboratory, Bellvitge Biomedical Research Institute, Barcelona, Spain
| | - Antoine Durrbach
- Department of Nephrology, Dialysis and Transplantation, Institut Francilien de Recherche en Nephrologie et Transplantation, Paris-Sud University, Le Kremlin Bicetre, France.,INSERM UMRS 1197, Villejuif, France
| | - Peggy Perrin
- Nephrology-Transplantation Department, University Hospital, Strasbourg, France
| | - Philippe Gatault
- Centre Hospitalier Régional Universitaire Bretonneau, Service de Néphrologie et Immunologie Clinique, Tours, France.,Université François-Rabelais, Tours, France
| | - Frederic Jambon
- Immuno ConcEpT, UMR CNRS 5164, Bordeaux, France.,Department of Nephrology, Dialysis and Transplantation, Bordeaux CHU, Bordeaux, France
| | | | - Laura Llado
- Liver Transplant Unit, Bellvitge University Hospital, Barcelona, Spain
| | - Camille Besch
- Hepato-pancreato-biliary Surgery and Liver Transplantation, Hopitaux Universitaires de Strasbourg, Hopital de Hautepierre, Strasbourg, France
| | - Louise Barbier
- Department of Digestive Surgery, Hepatobiliary Surgery and Liver Transplantation, Tours University Hospital.,FHU SUPORT, Tours, France.,INSERM, Poitiers, France
| | - Martine Neau-Cransac
- Department of Nephrology, Dialysis and Transplantation, Bordeaux CHU, Bordeaux, France
| | - Jérôme Dumortier
- Lyon Nursing Homes, Hôpital Edouard Herriot, Federation of Gastrointestinal Specialties, Lyon, France.,Claude Bernard University, Lyon, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, Toulouse University Hospital (Centre Hospitalier et Universitaire), Toulouse, France.,Faculty of Medicine, Paul Sabatier University, Toulouse, France.,Toulouse Purpan Physiopathology Center, French National Institute of Health and Medical Research (INSERM) Unité Mixte de Recherche 1043, Toulouse, France
| |
Collapse
|
4
|
Yazawa M, Cseprekal O, Helmick RA, Talwar M, Balaraman V, Podila PS, Agbim UA, Maliakkal B, Fossey S, Satapathy SK, Sumida K, Kovesdy CP, Nair S, Eason JD, Molnar MZ. Lack of Association between Pretransplant Donor-Specific Antibodies and Posttransplant Kidney Outcomes in Simultaneous Liver-Kidney Transplant Recipients with Rabbit Anti-Thymocyte Globulin Induction and Steroid-Free Protocol. Nephron Clin Pract 2020; 144:126-137. [DOI: 10.1159/000505460] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 12/15/2019] [Indexed: 11/19/2022] Open
|
5
|
Yazawa M, Cseprekal O, Helmick RA, Talwar M, Balaraman V, Podila PSB, Agbim UA, Maliakkal B, Fossey S, Satapathy SK, Sumida K, Kovesdy CP, Nair S, Eason JD, Molnar MZ. Association between post‐transplant donor‐specific antibodies and recipient outcomes in simultaneous liver–kidney transplant recipients: single‐center, cohort study. Transpl Int 2019; 33:202-215. [DOI: 10.1111/tri.13543] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 07/25/2019] [Accepted: 10/18/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Masahiko Yazawa
- James D. Eason Transplant Institute Methodist University Hospital Memphis TN USA
- Division of Transplant Surgery Department of Surgery University of Tennessee Health Science Center Memphis TN USA
- Division of Nephrology and Hypertension Department of Internal Medicine St. Marianna University School of Medicine Kawasaki Japan
| | - Orsolya Cseprekal
- James D. Eason Transplant Institute Methodist University Hospital Memphis TN USA
- Division of Transplant Surgery Department of Surgery University of Tennessee Health Science Center Memphis TN USA
- Department of Transplantation and Surgery Semmelweis University Budapest Hungary
| | - Ryan A. Helmick
- James D. Eason Transplant Institute Methodist University Hospital Memphis TN USA
- Division of Transplant Surgery Department of Surgery University of Tennessee Health Science Center Memphis TN USA
| | - Manish Talwar
- James D. Eason Transplant Institute Methodist University Hospital Memphis TN USA
- Division of Transplant Surgery Department of Surgery University of Tennessee Health Science Center Memphis TN USA
| | - Vasanthi Balaraman
- James D. Eason Transplant Institute Methodist University Hospital Memphis TN USA
- Division of Transplant Surgery Department of Surgery University of Tennessee Health Science Center Memphis TN USA
| | - Pradeep S. B. Podila
- Faith & Health Division Methodist Le Bonheur Healthcare Memphis TN USA
- Division of Health Systems Management & Policy School of Public Health The University of Memphis Memphis TN USA
| | - Uchenna A. Agbim
- James D. Eason Transplant Institute Methodist University Hospital Memphis TN USA
- Division of Transplant Surgery Department of Surgery University of Tennessee Health Science Center Memphis TN USA
| | - Benedict Maliakkal
- James D. Eason Transplant Institute Methodist University Hospital Memphis TN USA
- Division of Transplant Surgery Department of Surgery University of Tennessee Health Science Center Memphis TN USA
| | | | - Sanjaya K. Satapathy
- Department of Medicine Sandra Atlas Bass Center for Liver Diseases & Transplantation Northshore University Hospital/Northwell Health Manhasset NY USA
| | - Keiichi Sumida
- Division of Nephrology Department of Medicine University of Tennessee Health Science Center Memphis TN USA
| | - Csaba P. Kovesdy
- Division of Nephrology Department of Medicine University of Tennessee Health Science Center Memphis TN USA
- Nephrology Section Memphis Veterans Affairs Medical Center Memphis TN USA
| | - Satheesh Nair
- James D. Eason Transplant Institute Methodist University Hospital Memphis TN USA
- Division of Transplant Surgery Department of Surgery University of Tennessee Health Science Center Memphis TN USA
| | - James D. Eason
- James D. Eason Transplant Institute Methodist University Hospital Memphis TN USA
- Division of Transplant Surgery Department of Surgery University of Tennessee Health Science Center Memphis TN USA
| | - Miklos Z. Molnar
- James D. Eason Transplant Institute Methodist University Hospital Memphis TN USA
- Division of Transplant Surgery Department of Surgery University of Tennessee Health Science Center Memphis TN USA
- Department of Transplantation and Surgery Semmelweis University Budapest Hungary
- Division of Nephrology Department of Medicine University of Tennessee Health Science Center Memphis TN USA
| |
Collapse
|
6
|
Cannon RM, Davis EG, Jones CM. A Tale of Two Kidneys: Differences in Graft Survival for Kidneys Allocated to Simultaneous Liver Kidney Transplant Compared with Contralateral Kidney from the Same Donor. J Am Coll Surg 2019; 229:7-17. [DOI: 10.1016/j.jamcollsurg.2019.04.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/28/2019] [Accepted: 04/15/2019] [Indexed: 12/21/2022]
|
7
|
Szymczak M, Kaliciński P, Kowalewski G, Markiewicz-Kijewska M, Broniszczak D, Ismail H, Stefanowicz M, Kowalski A, Rubik J, Jankowska I, Piątosa B, Teisseyre J, Grenda R. Combined Liver-Kidney Transplantation in Children: Single-Center Experiences and Long-Term Results. Transplant Proc 2018; 50:2140-2144. [PMID: 30177126 DOI: 10.1016/j.transproceed.2018.04.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 04/26/2018] [Indexed: 12/23/2022]
Abstract
Combined liver-kidney transplantation (CLKT) is a rare procedure in pediatric patients in which liver and kidney from 1 donor are transplanted to a recipient during a single operation. The aim of our study was to analyze indications and results of CLKT in children. MATERIALS AND METHODS Between 1990 and 2017 we performed 722 liver transplantations in children; we performed 920 kidney transplantations in children since 1984. Among them, 25 received CLKT. Primary diagnosis was fibro-polycystic liver and kidney disease in 17 patients, primary hyperoxaluria type 1 in 6 patients, and atypical hemolytic uremic syndrome-related renal failure in 2 children. Age of patients at CLKT was 3 to 23 years (median 16 years) and body mass was 11 to 55 kg (median 35.5kg). All patients received whole liver graft. Kidney graft was transplanted after liver reperfusion before biliary anastomosis. Cold ischemia time was 5.5 to 13.3 hours (median 9.4 hours) for liver transplants and 7.3 to 15 hours (median 10.4 hours) for kidney transplants. In 8 patients X-match was positive. We analyzed posttransplant (Tx) course and late results in our group of pediatric recipients of combined grafts. RESULTS Tx follow-up ranged from 1.5 to 17 years (median 4.5 years). Two patients died: 1 patient with oxalosis lost renal graft and died 2.6 years after Tx due to complications of long-term dialysis, and 1 died due to massive bleeding in early postoperative period. Twelve patients were transferred under the care of adult transplantation centers. Six patients were dialyzed after CLKT due to acute tubular necrosis, and time of kidney function recovery was 10 to 27 days in these patients. In 1 patient with aHUS, renal function did not recover. In children with oxalosis, hemodialysis was performed for 1 month after Tx as a standard, with the aim to remove accumulated oxalate. Primary immunosuppression consisted of daclizumab or basiliximab, tacrolimus, mycophenolate mofetil, and steroids. Acute rejection occurred in 4 liver and 3 kidney grafts. One patient required liver retransplantation due to hepatitis C virus recurrence and 2 patients required kidney retransplantation. Two patients required dialysis. CONCLUSIONS CLKT in children results in low rate of rejection and high rate of patient and graft survival.
Collapse
Affiliation(s)
- M Szymczak
- Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Health Institute, Warsaw, Poland
| | - P Kaliciński
- Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Health Institute, Warsaw, Poland
| | - G Kowalewski
- Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Health Institute, Warsaw, Poland.
| | - M Markiewicz-Kijewska
- Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Health Institute, Warsaw, Poland
| | - D Broniszczak
- Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Health Institute, Warsaw, Poland
| | - H Ismail
- Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Health Institute, Warsaw, Poland
| | - M Stefanowicz
- Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Health Institute, Warsaw, Poland
| | - A Kowalski
- Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Health Institute, Warsaw, Poland
| | - J Rubik
- Department of Nephrology, Kidney Transplantation, and Arterial Hypertension, Children's Memorial Health Institute, Warsaw, Poland
| | - I Jankowska
- Department of Gastroenterology and Hepatology, Children's Memorial Health Institute, Warsaw, Poland
| | - B Piątosa
- Histocompatibility Laboratory, Children's Memorial Health Institute, Warsaw, Poland
| | - J Teisseyre
- Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Health Institute, Warsaw, Poland
| | - R Grenda
- Department of Nephrology, Kidney Transplantation, and Arterial Hypertension, Children's Memorial Health Institute, Warsaw, Poland
| |
Collapse
|
8
|
Zhang G, Zhu Y, Qin W, Yu L, Wu G, Ma S, Wang F, Qin R, Yang X, Tao K, Yue S, Zhao G, Yang Z, Yuan J, Dou K, Yuan J. Combined Kidney Transplantation and Splenic Fossa Auxiliary Heterotopic Liver Transplantation in a Highly Sensitized Recipient: A Case Report. Transplant Proc 2017; 48:3191-3196. [PMID: 27932179 DOI: 10.1016/j.transproceed.2016.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 08/23/2016] [Accepted: 09/01/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Combined kidney and auxiliary orthotopic liver transplantation from the same donor is used to treat highly sensitized renal transplant recipients. Auxiliary liver can protect the transplanted kidney against hyperacute rejection. METHODS In the current case, combined kidney and splenic fossa auxiliary heterotopic liver transplantation was performed from the same donor for a highly sensitized recipient without preoperative preconditioning. No postoperative hyperacute rejection occurred. RESULTS Seven days after surgery, preexisting antibody levels rose and decreased after treatment; meanwhile, the function of transplanted kidney returned to normal. During 24 months of follow-up, the grafts showed good blood perfusion and functioned well. The levels of preexisting antibodies, donor-specific antibodies (DSA) and C1q-fixing human leukocyte antigen (C1q-HLA) antibodies, all decreased. CONCLUSIONS Combined kidney and splenic fossa auxiliary heterotopic liver transplantation can be used in renal transplantation for highly sensitized recipients.
Collapse
Affiliation(s)
- G Zhang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Shanxi, China
| | - Y Zhu
- Department of Urology, Hanzhong Central Hospital, Shanxi, China
| | - W Qin
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Shanxi, China
| | - L Yu
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Shanxi, China
| | - G Wu
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Shanxi, China
| | - S Ma
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Shanxi, China
| | - F Wang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Shanxi, China
| | - R Qin
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Shanxi, China
| | - X Yang
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Shanxi, China
| | - K Tao
- Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University, Shanxi, China
| | - S Yue
- Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University, Shanxi, China
| | - G Zhao
- Xijing Orthopedic Hospital of the Fourth Military Medical University, Shanxi, China
| | - Z Yang
- Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University, Shanxi, China
| | - J Yuan
- Department of Biochemistry, University of Washington, Seattle, Washington
| | - K Dou
- Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University, Shanxi, China
| | - J Yuan
- Department of Urology, Xijing Hospital, Fourth Military Medical University, Shanxi, China.
| |
Collapse
|
9
|
Ganschow R, Hoppe B. Review of combined liver and kidney transplantation in children. Pediatr Transplant 2015; 19:820-6. [PMID: 26354144 DOI: 10.1111/petr.12593] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2015] [Indexed: 12/25/2022]
Abstract
In this review, we focused on CLKT with regard to indication, results, outcome, and future developments. PH1 is one of the most common diagnoses for adult and pediatric patients qualifying for CLKT. The other major indication for combined transplantation is ARPKD. CLKT appears to be superior to sequential liver and kidney transplantation in the majority of patients and overall results following CLKT are now good, even in small children. Clinical observations suggest that there is an immunological advantage of CLKT in comparison with isolated liver or kidney transplantation. More clinical studies are necessary to identify the best candidates for CLKT while the availability of donor organs is low.
Collapse
Affiliation(s)
- Rainer Ganschow
- Department of Pediatrics, University Medical Center, Bonn, Germany
| | - Bernd Hoppe
- Department of Pediatrics, University Medical Center, Bonn, Germany
| |
Collapse
|
10
|
Yan S, Ding Y, Tian Y, Lu Z, Wang Y, Zhang Q, Ye Y, Zhou L, Xie H, Chen H, Zheng M, Zheng S. MHC-mismatched mice liver transplantation promotes tumor growth in liver graft. Cancer Lett 2014; 351:162-71. [PMID: 24880081 DOI: 10.1016/j.canlet.2014.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 04/19/2014] [Accepted: 05/11/2014] [Indexed: 12/18/2022]
Abstract
Liver transplantation is a final therapeutic option for treatment of hepatic malignancies, but local recurrence remains high after surgery. However, the underlying mechanisms of local tumor recurrence are still unknown. We speculated that immunological status of transplanted liver may contribute to the progress of tumor development. CT-26 tumor cells are injected into graft after allogeneic or syngeneic liver transplantation. The growth pattern of tumor and the co-relationship of regulatory T cell and effector T cells in liver graft were observed and investigated at 3d, 6d, 9d and 15d post-transplantation. The Hepatic Replacement Area of tumor in allogeneic grafts was significantly larger than that in syngeneic grafts. The activation of tumor growth in allografts was due to the dysfunction of effector T cells mediated by regulatory T cells in liver graft. Using nude mice model, we further confirmed that regulatory T cells from allograft significantly weaken the function of effector T cells in vivo. Our data has showed that MHC-mismatched mice liver transplantation can promote tumor growth in liver graft. For the first time, we demonstrated that susceptibility to tumor development in liver graft is due to the down-regulation of effector T cells' function mediated by the regulatory T cells.
Collapse
Affiliation(s)
- Sheng Yan
- Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China; Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China; Key Laboratory of Organ Transplantation Zhejiang Province, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China
| | - Yuan Ding
- Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China; Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China; Key Laboratory of Organ Transplantation Zhejiang Province, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China
| | - Yang Tian
- Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China; Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China; Key Laboratory of Organ Transplantation Zhejiang Province, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China
| | - Zhongjie Lu
- Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China; Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China; Key Laboratory of Organ Transplantation Zhejiang Province, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China
| | - Yan Wang
- Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China; Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China; Key Laboratory of Organ Transplantation Zhejiang Province, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China
| | - Qiyi Zhang
- Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China; Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China; Key Laboratory of Organ Transplantation Zhejiang Province, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China
| | - Yufu Ye
- Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China; Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China; Key Laboratory of Organ Transplantation Zhejiang Province, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China
| | - Lin Zhou
- Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China; Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China; Key Laboratory of Organ Transplantation Zhejiang Province, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China
| | - Haiyang Xie
- Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China; Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China; Key Laboratory of Organ Transplantation Zhejiang Province, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China
| | - Hui Chen
- Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China; Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China; Key Laboratory of Organ Transplantation Zhejiang Province, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China
| | - Minghao Zheng
- Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China; Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China; Key Laboratory of Organ Transplantation Zhejiang Province, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China; Centre for Orthopaedic Research, School of Surgery, University of Western Australia, Western Australia 6009, Australia.
| | - Shusen Zheng
- Division of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China; Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China; Key Laboratory of Organ Transplantation Zhejiang Province, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China.
| |
Collapse
|