Association between post‐transplant donor‐specific antibodies and recipient outcomes in simultaneous liver–kidney transplant recipients: single‐center, cohort study

• Published in: Transplant international Vol. 33; no. 2; pp. 202 - 215
• Main Authors: Yazawa, Masahiko, Cseprekal, Orsolya, Helmick, Ryan A., Talwar, Manish, Balaraman, Vasanthi, Podila, Pradeep S. B., Agbim, Uchenna A., Maliakkal, Benedict, Fossey, Sallyanne, Satapathy, Sanjaya K., Sumida, Keiichi, Kovesdy, Csaba P., Nair, Satheesh, Eason, James D., Molnar, Miklos Z.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.02.2020
• Subjects: Allografts; Antibodies; C1q binding donor‐specific antibodies; Cohort analysis; Confidence intervals; de novo donor‐specific antibodies; donor‐specific antibodies; Graft rejection; Health hazards; Health risk assessment; Kidney transplantation; Kidney transplants; Kidneys; Liver; Liver transplantation; Mortality; Patients; Regression analysis; Regression models; simultaneous liver–kidney transplantation; Statistical analysis; Time dependence; donor-specific antibodies; simultaneous liver-kidney transplantation; de novo donor-specific antibodies; C1q binding donor-specific antibodies
• ISSN: 0934-0874; 1432-2277
• DOI: 10.1111/tri.13543

Summary There is a dearth of published data regarding the presence of post‐transplant donor‐specific antibodies (DSA), especially C1q‐binding DSA (C1q+DSA), and patient and kidney allograft outcomes in simultaneous liver–kidney transplant (SLKT) recipients. We conducted a retrospective cohort study consisted of 85 consecutive SLKT patients between 2009 and 2018 in our center. Associations between presence of post‐transplant DSA, including persistent and/or newly developed DSA and C1q+DSA, and all‐cause mortality and the composite outcome of mortality, allograft kidney loss, and antibody‐mediated rejection were examined using unadjusted and age and sex‐adjusted Cox proportional hazards and time‐dependent regression models. The mean age at SLKT was 56 years and 60% of the patients were male. Twelve patients (14%) had post‐transplant DSA and seven patients (8%) had C1q+DSA. The presence of post‐transplant DSA was significantly associated with increased risk of mortality (unadjusted model: Hazard Ratio (HR) = 2.72, 95% confidence interval (CI): 1.06–6.98 and adjusted model: HR = 3.20, 95% CI: 1.11–9.22) and the composite outcome (unadjusted model: HR = 3.18, 95% CI: 1.31–7.68 and adjusted model: HR = 3.93, 95% CI: 1.39–11.10). There was also higher risk for outcomes in recipients with C1q+DSA compared the ones without C1q+DSA. Post‐transplant DSA is significantly associated with worse patient and kidney allograft outcomes in SLKT. Further prospective and large cohort studies are warranted to better assess these associations.