Excellent Long-Term Outcome in a Staged, Simultaneous Liver-Kidney Transplantation of a Highly Sensitized Pediatric Patient With B and T Cell Positive Crossmatch.
Margret Bock, Eric Benz, Eliza Blanchette et al.
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Case in brief
A highly sensitized small child with high-titer class I and II donor-specific antibodies underwent staged simultaneous liver-kidney transplantation from the same donor despite a positive cytotoxic crossmatch. After liver transplantation, T-cell flow crossmatch was negative but B-cell flow remained positive; 18 hours later, before kidney graft perfusion, the T-cell result remained negative and the B-cell result was weakly positive. The child had immediate urine output and normalization of liver and kidney markers. At five years, both grafts functioned well with no de novo donor-specific antibodies, although non-HLA antibody-mediated rejection affected the liver one year after transplantation.
What made this case unusual
The kidney transplant was delayed 18 hours after the liver transplant in a highly sensitized child with positive crossmatches and high donor-specific antibody titers; the authors considered that the liver may have absorbed circulating antibodies and T cells.
Diagnostic / clinical pearl
In this case, serial crossmatch findings after liver transplantation informed the timing of kidney graft perfusion; persistent B-cell positivity was interpreted cautiously because rituximab may have affected the result.