1 University of Washington Medical Center, Seattle, WA. 2 Address correspondence to: Nicolae Leca, M.D., University of Washington Medical Center, 1959 NE Pacific Street, Box 356174, Seattle, WA.
Transplantation. 2013 Nov 27;96(10):914-8. doi: 10.1097/TP.0b013e3182a192f5.
The protective effect of the liver allograft when simultaneously transplanted with a kidney in the setting of allosensitization is unclear.
We analyzed the significance of sensitization, defined based on positive cytotoxicity crossmatches, positive flow cytometry crossmatches, and/or the presence of high levels of donor-specific antibodies, on the outcomes of simultaneous liver and kidney (SLK) transplantation. We reviewed 56 SLK performed at our center through December 31, 2011 and identified 13 patients who met high sensitization criteria.
Median patient survival was not significantly different: 86 months (95% confidence interval [CI], 47-135) for nonsensitized patients versus 151 months (95% CI, 4 to ∞) for sensitized patients (P=0.5). The 5-year survival was 67% (95% CI, 0.5-0.8) in the nonsensitized group and 64% (95% CI, 0.3-0.9) in the sensitized group. There were six renal allograft failures in the nonsensitized group but none in the sensitized group. The adjusted hazard ratios associated with the risk of death or the combined risk of death or renal allograft failure were 0.7 (95% CI, 0.1-3.8) and 0.4 (95% CI, 0.1-2.2) for sensitized versus nonsensitized patients. There were significantly more renal allograft rejections in the sensitized group (5 vs. 1; P=0.002) in the first year after transplantation, only one showing C4d positivity. Creatinine levels at 1 year after transplantation were similar: 1.5 mg/dL in the nonsensitized group versus 1.36 mg/dL in the sensitized group (P=0.6).
Sensitization does not appear to have a significant negative impact on the survival of SLK patients.
在同种致敏状态下同时移植肝脏和肾脏时，对供体肝脏的保护作用尚不清楚。
我们分析了基于细胞毒性交叉配型阳性、流式细胞术交叉配型阳性和/或存在高水平供体特异性抗体的致敏状态对同时肝肾（SLK）移植结局的意义。我们回顾了 2011 年 12 月 31 日之前在我们中心进行的 56 例 SLK，并确定了 13 例符合高致敏标准的患者。
中位患者生存率无显著差异：非致敏患者为 86 个月（95%置信区间[CI]，47-135），致敏患者为 151 个月（95%CI，4 至∞）（P=0.5）。非致敏组 5 年生存率为 67%（95%CI，0.5-0.8），致敏组为 64%（95%CI，0.3-0.9）。非致敏组有 6 例肾移植失败，而致敏组无肾移植失败。死亡或死亡加肾移植失败风险的调整后风险比分别为致敏组 0.7（95%CI，0.1-3.8）和 0.4（95%CI，0.1-2.2）。致敏组在移植后第一年发生更多的肾移植排斥反应（5 例与 1 例；P=0.002），仅 1 例显示 C4d 阳性。移植后 1 年时的肌酐水平相似：非致敏组为 1.5mg/dL，致敏组为 1.36mg/dL（P=0.6）。
致敏状态似乎对 SLK 患者的生存率没有显著的负面影响。
