%0 Journal Article %J Am J Transplant %D 2009 %T Acute humoral rejection in an ABO compatible combined liver-kidney transplant--the kidney is not always protected %A Reichman,T. W. %A Marino,S. R. %A Milner,J. %A Harland,R. C. %A Cochrane,A. %A Millis,J. M. %A Testa,G. %K ABO Blood-Group System / *immunology %K Antibodies, Monoclonal / therapeutic use %K Graft Rejection / *diagnosis / *immunology / therapy %K Histocompatibility / *immunology %K Humans %K Immunity, Humoral / *immunology %K Immunoglobulins, Intravenous / therapeutic use %K Immunologic Factors / therapeutic use %K Kidney Failure, Chronic / surgery %K Kidney Transplantation / *immunology %K Liver Diseases / surgery %K Liver Transplantation / *immunology %K Male %K Middle Aged %K Plasmapheresis %K Treatment Outcome %X 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. %B Am J Transplant %7 39980 %V 9 %P 1957 - 60 %8 Aug %G eng %N 8 %M 19522875 %R AJT2714 [pii] 10.1111/j.1600-6143.2009.02714.x