Combined Liver-Kidney Transplants: Allosensitization and Recipient Outcomes
Combined Liver-Kidney Transplants: Allosensitization and Recipient Outcomes
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DOI：
10.1097/tp.0b013e3182184181
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发表时间：
2011-06-15
期刊：
影响因子：
6.2
通讯作者：
Srinivas, Titte R.
中科院分区：
文献类型：
--
作者：
Askar, Medhat;Schold, Jesse D.;Srinivas, Titte R.
背景资料。根据已报道的同种异体肝移植的免疫保护作用，联合肝肾移植(CLK)的移植前阳性交叉配型不被认为是禁忌症。然而，近些年来，抗体介导的CLK肾排斥反应已有报道。这促使我们的研究调查预敏治疗对CLK受者结局的影响。我们使用1995年至2008年CLK的移植受者科学登记数据，通过致敏的指征来检查移植肾和患者的存活率。我们将致敏定义为群体反应性抗体(PRA)>10%或阳性T细胞交叉配型(TXM)。在2484例有PRA或TXM信息的CLK受者中，有30%的患者TXM或PRA阳性超过10%。在那些有TXM信息的人中，12%的人有阳性交叉匹配(n=234)。在单变量分析中，致敏患者的患者(P=0.002)和移植肾的总体存活率(P=0.015)显著降低。在多变量COX模型中，患者存活的差异转化为非致敏受者的估计半衰期为10.3年，致敏受者的半衰期为7.8年。在多变量COX模型中，异体致敏与患者死亡(调整后的风险比=1.22，95%CI，1.04-1.43)和总体肾功能丧失(调整后的风险比=1.16，95%CI，1.00-1.36)独立相关。这些结果表明，在CLK中，预敏治疗对患者和移植肾的总体存活率有负面影响。因此，在CLK的风险分层和临床处理中可能需要考虑预敏治疗。
Background. A pretransplant positive crossmatch in combined liver kidney transplants (CLK) is not considered a contraindication based on the reported immunoprotection conferred by the liver allograft. However, antibody-mediated rejection of the kidney in CLK has been reported recently. This prompted our study to investigate the impact of presensitization on CLK recipient outcomes.Methods. We examined kidney allograft and patient survival by indication of sensitization using Scientific Registry of Transplant Recipients data on CLK performed from 1995 to 2008. We defined sensitization as panel reactive antibody (PRA) more than 10% or a positive T-cell crossmatch (TXM).Results. Among 2484 CLK recipients with available PRA or TXM information, 30% had positive TXM or PRA more than 10%. Among those with TXM information, 12% had a positive crossmatch (n = 234). In univariate analyses, patient (P = 0.002) and overall kidney graft survival (P = 0.015) were significantly diminished among sensitized patients. Differences in patient survival translated to estimated half-lives of 10.3 years among nonsensitized recipients versus 7.8 years among sensitized recipients, In multivariable Cox models, allosensitization was independently associated with patient death (adjusted hazard ratio = 1.22, 95% CI, 1.04-1.43) and overall kidney graft loss (adjusted hazard ratio = 1.16, 95% CI, 1.00-1.36).Conclusions. These results suggest a negative impact of presensitization on patient and overall renal allograft survival in CLK. Accordingly, presensitization may need to be considered in risk stratification and clinical management of CLK.