Acute humoral rejection in an ABO compatible combined liver-kidney transplant - The kidney is not always protected

T. W. Reichman, S. R. Marino, J. Milner, R. C. Harland, A. Cochrane, J. M. Millis, G. Testa

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Combined liver-kidney transplantation has become a common practice for the treatment of patients with concurrent end-stage renal disease and end-stage liver disease. Liver transplantation in the setting of multiorgan transplantation is thought to have a protective effect against humoral rejection even when a positive crossmatch is obtained prior to surgery. In most centers, a pre liver-kidney transplant crossmatch is rarely performed because of the known immunoprotective effect of the liver allograft. In this report, a case of acute humoral rejection in the kidney allograft after a combined liver-kidney transplant is described. Although humoral rejection was treated using plasmapheresis, intravenous immunoglobulin and rituximab, the kidney required 3 months to recover function and finally progressed to chronic allograft nephropathy. A heightened index of suspicion for acute humoral rejection of the renal allograft is necessary when performing combined liver-kidney transplants to highly sensitized patients due to previous organ transplants.

Original languageEnglish (US)
Pages (from-to)1957-1960
Number of pages4
JournalAmerican Journal of Transplantation
Issue number8
StatePublished - Aug 2009
Externally publishedYes


  • Humoral allograft rejection
  • Kidney allograft
  • Kidney graft survival
  • Liver transplantation
  • Sensitised transplant recipient

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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