Combined liver and kidney transplantation in a highly sensitized and positively cross-matched patient

Abstract

Combined liver kidney transplantation (CLKT) has been used on many occasions and proved to be a successful event for both liver and kidney in highly sensitized patients. Our aim was to review the immunological and other laboratory results of a CLKT in a highly sensitized patient. CLKT was used to treat a highly sensitized, 42-year-old female. She was suffering from end-stage liver disease due to hepatitis C virus (HCV) infection and renal disease due to diabetic nephropathy. Cross-matching, panel reactive assay (PRA) and routine laboratory tests for liver and renal function were carried out before and after the CLKT. Prior to the CLKT, the patient was highly sensitized with human leukocytes antigens (anti-HLA) class I antibodies (>90%). Patient was offered CLKT from a deceased donor. She had donor-specific antibodies, class I and II. Both T and B CDC cross-matches (XM) were positive pre-transplant and eight hours post-transplant. Both cross-match and PRA results became completely negative six days post CKLT. Almost 30 months post CLKT, her renal function is normal and negative for class I and II PRA. Liver graft appears to be protective for renal graft when they are combined even in highly sensitized patients. CLKT is very useful in overcoming sensitization in addition to treating end-stage liver and renal diseases.