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Successful Combined Partial Auxiliary Liver and Kidney Transplantation in Highly Sensitized Cross‐Match Positive Recipients
Author(s) -
Olausson M.,
Mjörnstedt L.,
Nordén G.,
Rydberg L.,
Mölne J.,
Bäckman L.,
Friman S.
Publication year - 2007
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2006.01592.x
Subject(s) - medicine , kidney , transplantation , kidney transplantation , liver transplantation , antibody , human leukocyte antigen , urology , renal function , gastroenterology , surgery , immunology , antigen
Combined liver and renal transplantations can be performed against a positive cross‐match, indicating that the liver protects the kidney from the harmful HLA antibodies. This led us to the hypothesis that a partial auxiliary liver graft may have a similar protective effect when performed together with the kidney in highly sensitized patients. Seven patients, with broadly reacting HLA antibodies and positive crossmatches, were transplanted with a partial liver and a kidney from the same donor. In one of the cases a living donor was used. We performed lymphocytotoxic and flow cross‐matches before and after the transplantation. Cross‐matches turned negative after grafting in five of seven cases. The kidney function was excellent, without rejections, during the follow‐up (24–60 months) in these patients. In two cases the cross‐match remained positive after transplantation, one with a never‐functioning renal graft and the other with an early graft failure, probably due to humoral rejection. A simultaneous transplantation of a partial auxiliary liver graft from the same donor, with the sole purpose of protecting the kidney from harmful lymphocytotoxic antibodies, can be performed successfully despite a positive cross‐match and may thus be a new option of treatment for highly sensitized patients waiting for a kidney transplant.