Outcome of simultaneous liver-kidney transplantation in highly sensitized, crossmatch-positive patients
Outcome of simultaneous liver-kidney transplantation in highly sensitized, crossmatch-positive patients
复制标题
DOI：
10.1016/s0041-1345(03)00621-3
复制
发表时间：
2003-08-01
影响因子：
0.9
通讯作者：
Oppenheimer, F
中科院分区：
文献类型：
--
作者：
Gutiérrez, A;Crespo, M;Oppenheimer, F
背景资料。在肝肾联合移植(SLKT)中，肝脏被描述为保护肾脏免受排斥，尽管移植前交叉配型为阳性，但仍有可能获得可接受的结果。自1993年以来，我们中心共进行了21例SLKT，其中2例为阳性交叉配型。在这项研究中，我们回顾分析了两例移植前交叉配型阳性后的SLKT。对两名高度敏感的女性(30岁和52岁)在首次KT失败后进行血液透析的肝硬变VHC进行评估。补体依赖性细胞毒NIH(CDC)诱导的移植前群体反应性抗体(PRA)分别为81%和99%。两名患者都接受了SLKT。分别于移植前、移植后24、48小时用CDC和流式细胞仪进行CD3-PE和抗人免疫球蛋白-FITC双标记。患者接受ATG、环孢素A和强的松治疗。移植前CDC和流式细胞仪检测CM均为阳性。48h时CDC几乎为阴性(死亡率为10%~20%)，流式细胞仪检测为阴性。其中一名患者在移植后10天经历了急性排斥反应，并通过类固醇脉冲缓解。两例患者术后26个月和24个月均有工作移植物(Cr1.1和1.5 mg/dL；GOT 34和14IU/L；GTP 29和12IU/L；GGT 9和66IU/L)。我们的经验表明，阳性交叉配型并不是SLKT的绝对禁忌症。即使在高度敏感的患者中，良好的移植物和患者存活率也是可能的。
Background. In simultaneous liver-kidney transplantation (SLKT), the liver has been described to protect the kidney from rejection, and acceptable results are possible despite a pretransplant positive crossmatch. At our center, 21 SLKT have been performed since 1993, 2 of them against a positive crossmatch.Objectives. In this study we retrospectively analyzed two cases of SLKT after positive pretransplant crossmatch.Methods. Two highly sensitized women (30 and 52 years) with hepatic cirrhosis VHC on hemodialysis after a first KT failure were assessed. Pretransplant panel reactive antibodies (PRA) by complement dependent cytotoxicity NIH (CDC) were 81% and 99% respectively. Both patients received a SLKT. CM was performed at pretransplant and 24 and 48 hours posttransplant by CDC and by flow cytometry with double labeling with CD3-PE and antihuman IgG-FITC. Patients received ATG, cyclosporine, and prednisone therapy.Results. CM was positive pretransplant by CDC and flow cytometry. At 48 hours, CDC became almost negative (10%-20% mortality) and flow cytometry became negative. One of the patients experienced an episode of acute rejection at 10 days posttransplant that resolved with steroid pulses. Both patients presently have working grafts 26 and 24 months posttransplant (Cr, 1.1 and 1.5 mg/dL; GOT, 34 and 14 IU/L; GTP, 29 and 12 IU/L; GGT, 9 and 66 IU/L).Conclusions. Our experience suggests that a positive crossmatch is not an absolute contraindication for SLKT. Good graft and patient survival rates are possible even among highly sensitized patients.