THE VERY RAPID LOSS OF DONOR SPECIFIC ANTIBODIES FROM THE CIRCULATION AFTER LIVER TRANSPLANTATION ALLOWS SUCCESSFUL KIDNEY TRANSPLANTATION FROM THE SAME DONOR FOR EVEN THE MOST HIGHLY SENSITIZED PATIENTS.

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THE VERY RAPID LOSS OF DONOR SPECIFIC ANTIBODIES FROM THE CIRCULATION AFTER LIVER TRANSPLANTATION ALLOWS SUCCESSFUL KIDNEY TRANSPLANTATION FROM THE SAME DONOR FOR EVEN THE MOST HIGHLY SENSITIZED PATIENTS.
Marilyn S. Pollack, Ph.D. . San Antonio TX, University of Texas Health Science Center, 78229, Department of Pathology .

Several published case reports have documented that a liver transplant can protect a kidney transplant from the same donor from antibody mediated rejection even in the case of highly sensitized, crossmatch positive patients. However, a major review article published in 1994 concluded that preformed lymphocytotixc antibodies could have a deleterious effect on graft survival in at least some combined liver-kidney transplant recipients. Moreover, the mechanism by which the kidney might be protected from alloantibodies (e.g., by absorption by the liver, by dilution from peri-transplant transfusions or by the transfusion of anti-idiotype antibodies) has not been certain. Substantial post-transplant testing for several of our own Transplant Program's sensitized liver and combined liver-kidney transplant recipients has indicated that the donor specific antibodies disappear immediately by absorption in the liver after transplant and that no antibody deposits can be detected in the kidney. The disappearance of donor specific antibodies cannot be explained by the effects of any peritransplant transfusions. Non-donor-specific antibodies are unaffected and anti-idiotype antibodies don't develop either in the short term or in the long term. Conversely, since sensitized patients often receive extra numbers of transfusions due to problems with the adverse effects of their antibodies on platelets, it is possible that antibodies in the peri-transfusion products themselves contributed to the kidney dysfunction reported for some liver-kidney transplant recipients in that earlier review article. Post-transplant antibody specificity and titer analyses for several of our own sensitized transplant recipients will be presented.