|
|||||
|
|
Association between post-transplant donor-specific antibodies and recipient outcomes in simultaneous liver–kidney transplant recipients: single-center,cohort study |
|
| Authors: | Masahiko Yazawa Orsolya Cseprekal Ryan A Helmick Manish Talwar Vasanthi Balaraman Pradeep S B Podila Uchenna A Agbim Benedict Maliakkal Sallyanne Fossey Sanjaya K Satapathy Keiichi Sumida Csaba P Kovesdy Satheesh Nair James D Eason Miklos Z Molnar |
| Institution: | 1. 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;2. 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;3. James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA;4. 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;5. 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;6. Transplant Immunology Laboratory, DCI Inc., Nashville, TN, USA;7. Department of Medicine, Sandra Atlas Bass Center for Liver Diseases & Transplantation, Northshore University Hospital/Northwell Health, Manhasset, NY, USA;8. Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA;9. 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 |
| Abstract: | There is a dearth of published data regarding the presence of post-transplant donor-specific antibodies (DSA), especially C1q-binding DSA (C1q+DSA), and patient and kidney allograft outcomes in simultaneous liver–kidney transplant (SLKT) recipients. We conducted a retrospective cohort study consisted of 85 consecutive SLKT patients between 2009 and 2018 in our center. Associations between presence of post-transplant DSA, including persistent and/or newly developed DSA and C1q+DSA, and all-cause mortality and the composite outcome of mortality, allograft kidney loss, and antibody-mediated rejection were examined using unadjusted and age and sex-adjusted Cox proportional hazards and time-dependent regression models. The mean age at SLKT was 56 years and 60% of the patients were male. Twelve patients (14%) had post-transplant DSA and seven patients (8%) had C1q+DSA. The presence of post-transplant DSA was significantly associated with increased risk of mortality (unadjusted model: Hazard Ratio (HR) = 2.72, 95% confidence interval (CI): 1.06–6.98 and adjusted model: HR = 3.20, 95% CI: 1.11–9.22) and the composite outcome (unadjusted model: HR = 3.18, 95% CI: 1.31–7.68 and adjusted model: HR = 3.93, 95% CI: 1.39–11.10). There was also higher risk for outcomes in recipients with C1q+DSA compared the ones without C1q+DSA. Post-transplant DSA is significantly associated with worse patient and kidney allograft outcomes in SLKT. Further prospective and large cohort studies are warranted to better assess these associations. |
| Keywords: | C1q binding donor-specific antibodies de novo donor-specific antibodies donor-specific antibodies simultaneous liver–kidney transplantation |