Successful sequential liver‐kidney transplantation in patients with preformed lymphocytotoxic antibodies

Abstract

Two patients with preformed lymphocytotoxic antibodies and strongly positive pretransplant crossmatches were transplanted with sequential liver and renal allografts from single donors. Following revascularization of the liver, demonstrable falls in the preformed lymphocytotoxic antibody levels were noted and subsequent crossmatches against the donor were negative. The renal allografts from the respective donors were transplanted without difficulty and in 2 instances both organs functioned well immediately. In instances when allograft rejection occurred in the post‐transplant period, successful reversal was accomplished by immunotherapy with OKT3 monoclonal anti‐human T cell antibody. The artifact caused by the use of OKT3 in crossmatches was also investigated. A sustained negative donor‐specific crossmatch was noted during the posttransplant period as well as a persistent decline in the percent reactive antibody levels.