Long‐term outcomes of crossmatch positive simultaneous liver–kidney transplantations in the United States

Abstract

The long‐term outcomes of positive crossmatch (+XM) simultaneous liver–kidney (SLK) transplantations are conflicting. We examined the association between crossmatch status and SLK outcomes in recipients discharged on tacrolimus and mycophenolate with or without steroids. We analyzed the Scientific Registry of Transplant Recipients for all primary SLK recipients between 2003 and 2020 with available crossmatch and induction data. We grouped recipients according to the crossmatch status: negative crossmatch (−XM; n = 3040) and +XM (n = 407). Kaplan–Meier curves were generated to examine recipient, death‐censored liver, and death‐censored kidney survival by crossmatch status. Cox proportional hazard models were used to investigate the association between crossmatch status and outcomes of interest with follow‐up censored at 10 years. Models were adjusted for recipient age, sex, diabetes mellitus, Model for End‐Stage Liver Disease score, duration on the liver waiting list, induction immunosuppression, steroid maintenance, hepatitis C infection, donor age and sex, local vs. shared organ, cold ischemia time, and previous liver transplantation status. In the univariable analysis, crossmatch status was not associated with recipient survival (log‐rank p = 0.63), death‐censored liver graft survival (log‐rank p = 0.05), or death‐censored kidney graft survival (log‐rank p = 0.11). Compared with −XM, +XM recipients had a similar 1‐year liver rejection rate, but higher kidney rejection rate (4.6% vs. 8.9%, p = 0.002). In the multivariable models, +XM status was not associated with deleterious long‐term recipient, liver, or kidney grafts survival. −XM and +XM SLK transplantations have comparable long‐term recipient, liver graft, and kidney survival with a slightly increased risk of early kidney allograft rejection in the +XM group. Crossmatch positivity in SLK transplantations should not influence the decision to use organs from a specific donor.

Examining the Role for Donor-specific Antibody Testing in Simultaneous Liver-kidney Transplantation: A Single-center Analysis of Outcomes

“…11 Although overall survival at 1 and 5 y was lower in the HIR patients, further multivariate analyses demonstrated that the only factor that significantly affected survival was a previous kidney transplant, not immunologic status. 11 A recent study by Riad et al 17 showed that patients with a positive crossmatch have a higher risk of early kidney rejection but otherwise comparable outcomes to crossmatch negative recipients. Another study described increased risk of both liver and kidney graft failure and overall patient mortality in SLKT patients with preformed class II DSA; however, confounding factors such as time on dialysis and previous transplant were not considered‚ and immunosuppression protocols were not standardized or current.…”

Alloantibody and crossmatch in simultaneous liver and kidney transplantation: Is the jury still out?

“…[ 1,2] Despite this, there is currently no consensus regarding the potential impact of prior sensitization or crossmatch testing in simultaneous liver and kidney transplantation (SLKT). Given the conflicting evidence across institutional studies regarding crossmatch results and donor-specific antibodies (DSAs) in SLKT, Riad et al [3] used the Scientific Registry of Transplant Recipients (SRTR) to broadly relate crossmatch results to patient outcomes (patient survival, death-censored kidney and liver graft survival) after SLKT and observed no major effect. We applaud the effort to study this complex population and important topic.…”