Abstract
Introduction:The impact of preformed donor-specific anti–human leukocyte antigen (HLA) antibodies(pDSAs) after combined liver-kidney transplantation (CLKT) is still uncertain.Methods:We conducted a retrospective study in 8 European high-volume transplant centers and inves-tigated the outcome of 166 consecutive CLKTs, including 46 patients with pDSAs.Results :Patient survival was lower in those with pDSAs (5-year patient survival rate of 63% and 78% with orwithout pDSA, respectively;P¼0.04). The presence of pDSAs with a meanfluorescence intensity (MFI)$5000(hazard ratio 4.96; 95% confidence interval: 2.3–10.9;P<0.001) and the presence of 3 or more pDSAs (hazardratio 6.5; 95% confidence interval: 2.5–18.8;P¼0.05) were independently associated with death. The death-censored liver graft survival was similar in patients with or without pDSAs. Kidney graft survival was compa-rable in both groups. (The 1- and 5-year death-censored graft survival rates were 91.6% and 79.5%, respectively,in patients with pDSAs and 93% and 88%, respectively, in the donor-specific antibody [DSA]-negative group,P¼not significant). Despite a higher rate of kidney graft rejection in patients with pDSAs (5-year kidney graft survivalrate without rejection of 87% and 97%with or without pDSAs, respectively;P¼0.04), kidney function did notstatistically differ between both groups at 5 years post-transplantation (estimated glomerularfiltration rate 4517 vs. 5729 ml/min per 1.73 m2, respectively, in patients with and without pDSAs). Five recipients with pDSAs(11.0%) experienced an antibody-mediated kidney rejection that led to graft loss in 1 patient.Conclusion:Our results suggest that CLKT with pDSAs is associated with a lower patients’survival despitegood recipients’, liver and kidney grafts’outcome.