Combined Kidney Transplantation And Splenic Fossa Auxiliary Heterotopic Liver Transplantation In A Highly Sensitized Recipient

Background:The renal transplantation technology has already become one of the best effective curative measures for curing the patients with the end-stage kidney disease. However, as for some patients who once suffered the transplantation, pregnancy and blood transfusion, their panel-reactive antibodies(PRA) tend to be higher and stay at “pre-sensitization” status before the plantation. The excessive PRA increases the possibility of donor specific antibody(DSA) existing in the body of the receptors. Such DSA pre-existing in the receptors is regarded as the main cause for the hyperacute rejection after the transplantation. However, once the hyperacute rejection occurs, apart from the excision of kidney graft, there are no better solutions at present. Therefore, in many transplantation centers, to test PRA is one of the indexes for the candidate transplantation receptors. It is quite difficult for the pre-sensitized receptors to find a kidney with the good type. In China, the extremely scarce kidneys are generally transplanted to PRA and DSA negative receptors. It makes many pre-sensitized transplantation receptors wait for a long time, and have to go through the dialysis continuously. Therefore, it is quite important to find out a proper curative proposal and let them go through the renal transplantation treatment promptly as other conventional renal transplantation receptors, and reduce or avoid the occurrence of the hyperacute rejection after the transplantation.To better solve the difficulty that the patients with uremia are difficult to receive a renal transplantation, the urinary surgery department of Xijing Hospital carried out bold attempt. On March 6th, 2014, it performed renal transplantation combining with the spleen fossa heterotopic auxiliary liver transplantation to cure a high-sensitized receptor with uremia(PRA I: 31%; PRA II: 63%). This operation is aimed at protecting the transplanted kidney from suffering the hypracute rejection. It was the first time for this department to treat the high-sensitized receptors through the renal transplantation combining with the spleen fossa heterotopic auxiliary liver transplantation. Objective:To study the clinical effectiveness and safety of combined kidney transplantation and splenic fossa auxiliary heterotopic liver transplantation in a treating highly sensitized recipients with uremia. Methods:To check the clinical effectivity and safety of this proposal, we collected the serum of the transplantation receptors before, after and during the operation in different observation time, and tested all preformed antibody change status through Luminex test technology, so as to verify whether the spleen fossa auxiliary transplanted liver has the protection effect on the renal transplantation during the whole transplantation period. Meanwhile, with regard to the serum collected in different time points, the change status of the DSA and C1q-fixing human leukocyte antigen(C1q-HLA) of the receptor is detected with the purpose of observing the humoral rejection reaction status of the receptor after the renal transplantation combining with the spleen fossa auxiliary renal transplantation. Results:No postoperative hyperacute rejection occurred. 7 days after the surgery, preexisting antibody levels rose, which decreased after treatment; meanwhile, the function of transplanted kidney returned to normal. During 14 months of follow-up, the grafts had good blood perfusion, and functioned well. Meanwhile, levels of preexisting antibodies, DSA and C1q-HLA, all decreased. Conclusions:Combined kidney transplantation and splenic fossa auxiliary heterotopic liver transplantation from the same donor can effectively solve the problem of kidney transplantation in highly sensitized patients with uremia.