Transplant Center, Cleveland Clinic, Cleveland, OH, USA.
Transplantation. 2011 Jun 15;91(11):1286-92. doi: 10.1097/TP.0b013e3182184181.
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.
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).
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).
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.
在肝肾联合移植（CLK）中，移植前的阳性交叉配型并不被认为是一个禁忌，因为肝移植可以提供免疫保护。然而，最近有报道称 CLK 中的抗体介导的肾排斥反应。这促使我们研究预致敏对 CLK 受者结局的影响。
我们使用 1995 年至 2008 年的 Scientific Registry of Transplant Recipients 数据，根据致敏情况检查了 CLK 患者的肾移植和患者存活率。我们将致敏定义为 PRA 大于 10%或 T 细胞交叉配型（TXM）阳性。
在 2484 例有可用 PRA 或 TXM 信息的 CLK 受者中，30%有阳性 TXM 或 PRA 大于 10%。在有 TXM 信息的患者中，12%有阳性交叉配型（n=234）。在单因素分析中，致敏患者的患者（P=0.002）和整体肾移植物存活率（P=0.015）显著降低。在多变量 Cox 模型中，同种致敏与患者死亡（调整后的危险比=1.22，95%CI，1.04-1.43）和整体肾移植物丢失（调整后的危险比=1.16，95%CI，1.00-1.36）独立相关。
这些结果表明，预致敏对 CLK 患者和整体肾移植受者的存活率有负面影响。因此，预致敏可能需要在 CLK 的风险分层和临床管理中加以考虑。
