Unique molecular changes in kidney allografts after simultaneous liver-kidney compared with solitary kidney transplantation

Kidney allografts transplanted simultaneously with liver allografts from the same donor are known to be immunologically privileged. This is especially evident in recipients with high levels of donor-specific anti-HLA antibodies. Here we investigated the mechanisms of liver’s protective impact using gene expression in the kidney allograft. Select solitary kidney transplant or simultaneous liver-kidney transplant recipients were retrospectively reviewed and separated into four groups: 16 cross-match negative kidney transplants, 15 cross-match positive kidney transplants, 12 cross-match negative simultaneous liver-kidney transplants, and nine cross-match–positive simultaneous liver-kidney transplants. Surveillance biopsies of cross-match–positive kidney transplants had increased expression of genes associated with donor-specific antigens, inflammation, and endothelial cell activation compared to cross-match–negative kidney transplants. These changes were not found in cross-match–positive simultaneous liver-kidney transplant biopsies when compared to cross-match–negative simultaneous liver-kidney transplants. In addition, simultaneously transplanting a liver markedly increased renal expression of genes associated with tissue integrity/metabolism, regardless of the cross-match status. While the expression of inflammatory gene sets in cross-match–positive simultaneous liver-kidney transplants was not completely reduced to the level of cross-match–negative kidney transplants, the downstream effects of donor-specific anti-HLA antibodies were blocked. Thus, simultaneous liver-kidney transplants can have a profound impact on the kidney allograft, not only by decreasing inflammation and avoiding endothelial cell activation in cross-match–positive recipients, but also by increasing processes associated with tissue integrity/metabolism by unknown mechanisms.