P002 Patient outcomes following liver-kidney transplantation with donor specific antibodies

Aim Simultaneous liver and kidney transplantation (SLKT) remains as the gold standard for patients with chronic renal and liver diseases. Pre-transplant donor-specific antibody (DSA) to class I antigens have been shown to decrease following SLKT; whereas, DSA to class II antigens may remain detrimental to long term graft survival. Methods We analyzed a cohort of SLKT performed at our institution from 2011 to 2017. We ran both flow and cytotoxic crossmatches pre-transplant and crossmatch positive samples were rerun in the post transplant period. We monitored for DSA both pre and post transplant using a single antigen bead assay. (One Lambda). Results There were 30 SLKT performed, of which 11 had pre-formed DSA (four class I and II DSA, five class I DSA only, two class II only). Strong donor specific anti-HLA antibodies were eliminated following SLKT for class I and II specificities while preserving anti-HLA antibodies against antigens that were not expressed on the donor. The presence of DSA lead to six positive flow cytometry crossmatches of which three were cytotoxic crossmatch positive. Repeat crossmatching with recipient serum post SLKT was found to be negative which correlated with the sharp decrease in DSA MFI detectable in recipient serum. Whether DSA in recipient serum was against class I, II or both antigens there was no significant difference in one-year patient or graft survival. Conclusions The liver absorbed the impact of DSA in our cohort of SLKT recipients. The SLKT recipient did well following transplant in the presence of DSA to class I, II or both. Given the high priority SLK patients receive, having strong DSA no matter the class with a positive XM result should not be a contraindication to transplant.