Humoral and cellular rejection after combined liver–kidney transplantation in low immunologic risk recipients


Jean Villard MD, PhD, Transplantation Immunology Unit, Division of Immunology and Allergy, Geneva University Hospital, 24 rue Micheli-du-Crest, 1211 Geneva 14, Switzerland. Tel.: +41 22 372 9394; fax: +41 22 372 9390; e-mail:


Combined liver–kidney transplantation is considered a low risk for immunologic complication. We report an unusual case of identical ABO liver–kidney recipient without preformed anti-human leukocyte antigen (HLA) antibodies, transplanted across a T- and B-cell-negative cross-match and complicated by early acute humoral and cellular rejection, first in the liver then in the kidney. While analyzing the immunologic complications in our cohort of 12 low-risk combined liver–kidney recipients, only one recipient experienced a rejection episode without detection of anti-HLA antibody over time. Although humoral or cellular rejection is rare after combined kidney-liver transplantation, our data suggest that even in low-risk recipients, the liver does not always systematically protect the kidney from acute rejection. Indeed, the detection of C4d in the liver should be carefully followed after combined liver–kidney transplantation.