Combined Kidney Transplantation And Splenic Fossa Auxiliary Heterotopic Liver Transplantation In Highly Sensitized Recipients With End-stage Renal Disease

Section 1 Combined Kidney Transplantation and Splenic Fossa Auxiliary Liver Transplantation in Highly Sensitized Recipients with End-Stage Renal Disease:Surgical Treatment and Follow-upObjective To evaluate the effectiveness of combined kidney transplantation and splenic fossa auxiliary liver transplantation in highly sensitized recipients.Methods We treated 3 highly sensitized recipients with combined kidney transplantation and splenic fossa auxiliary liver transplantation.Perioperative changes were recorded and serum antibodies were monitored with Luminex.Follow-up were performed when they discharged from hospital to evaluate the clinical effectiveness and safety of the surgical options.Results All 3 patients were successfully treated with the surgery and no hyperacute rejection occurred.Antibodies increased in 3 patients and acute AMR occurred at about 1 month after surgery.Two patients recovered after treatments and with a stable renal function during follow-up.The other patient lost his graft 5 months after surgery because he failed to reverse from AMR.Conclusions Hyperacute rejection can be avoided with combined kidney transplantation and splenic fossa auxiliary liver transplantation in highly sensitized recipients.However,we should be alert to the occurrence of acute AMR and deal with it in time.Section 2 Desensitization with Rituximab Combined Staphylococcal Protein A-Based ImmunoadsorptionObjective To evaluate the desensitization efficiency of rituximab combined with staphylococcal protein A-based immunoadsorption in highly sensitized patients with end-stage renal diseases.Methods A single dose of rituximab combined with staphylococcal protein A-based immunoadsorption was used to desensitization in a highly sensitized ESRD patient with 100% PRA.Serum samples were collected before and after each treatment for antibody detection.We analyzed the changes of HLA antibodies to evaluate the clearing efficiency.Results The mean MFI of HLA antibodies in the patient's serum showed a significant decrease after the first immunoadsorption therapy [(8858±338.8)vs(7663±321.1),P =0.0111].HLA-I antibodies decreased from(7659±451.6)to(6233±391.8),P =0.0187;HLA-II antibodies decreased from(10168±449.2)to(9224±429.3),p=0.1319.After the 3rd immunoadsorption,the mean MFI of HLA antibodies decreased to(5992±353.8),p<0.0001.HLA-I antibodies were reduced to(4697±411.1),P <0.0001;HLA-II antibodies were reduced to(7407±528.2),P<0.0001.Conclusions Rituximab combined with staphylococcal protein A-based immunoadsorption can significantly reduce the amount of antibody in the circulation,and provide a time window for highly sensitized patients to receive kidney transplantation.