Acute Humoral Rejection in an ABO Compatible Combined Liver–Kidney Transplant—The Kidney Is Not Always Protected |
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Authors: | T. W. Reichman S. R. Marino J. Milner R. C. Harland A. Cochrane J. M. Millis G. Testa |
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Affiliation: | Department of Surgery;, Department of Pathology;and Department of Pharmacology, University of Chicago Medical Center, Chicago, IL |
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Abstract: | Combined liver–kidney transplantation has become a common practice for the treatment of patients with concurrent end-stage renal disease and end-stage liver disease. Liver transplantation in the setting of multiorgan transplantation is thought to have a protective effect against humoral rejection even when a positive crossmatch is obtained prior to surgery. In most centers, a pre liver–kidney transplant crossmatch is rarely performed because of the known immunoprotective effect of the liver allograft. In this report, a case of acute humoral rejection in the kidney allograft after a combined liver–kidney transplant is described. Although humoral rejection was treated using plasmapheresis, intravenous immunoglobulin and rituximab, the kidney required 3 months to recover function and finally progressed to chronic allograft nephropathy. A heightened index of suspicion for acute humoral rejection of the renal allograft is necessary when performing combined liver–kidney transplants to highly sensitized patients due to previous organ transplants. |
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Keywords: | Humoral allograft rejection kidney allograft kidney graft survival liver transplantation sensitised transplant recipient |
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