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Abstract：
Simultaneous liver and kidney (SLK) transplantation is considered the best treatment modality among selected patients with both chronic kidney disease (CKD) and end-stage liver disease (ESLD). Since the first SLK transplant in 1983, the number of SLK transplants has increased worldwide, and particularly in the United States since the implementation of the MELD system in 2002. SLK transplants are considered a relatively low immunological risk procedure evidenced by multiple studies displaying the immunomodulatory properties of the liver on the immune system of SLK recipients. SLK recipients demonstrate lower rates of both cellular and antibody-mediated rejection on the kidney allograft when compared to kidney transplant-alone recipients. Therefore, SLK transplants in the setting of preformed donor-specific HLA antibodies (DSA) are a common practice, at many centers. Acceptance and transplantation of SLKs are based solely on ABO compatibility without much consideration of crossmatch results or DSA levels. However, some studies suggest an increased risk for rejection for SLK recipients transplanted across high levels of pre-formed HLA DSA. Despite this, there is no consensus regarding acceptable levels of pre-formed DSA, the role of pre-transplant desensitization, splenectomy, or immunosuppressive management in this unique population. Also, the impact of post-transplant DSA monitoring on long-term outcomes is not well-studied in SLK recipients. In this article, we review recent and relevant past articles in this field with a focus on the immunological risk factors among SLK recipients, and strategies to mitigate the negative outcomes among them.
摘要：
同时进行肝和肾（SLK）移植被认为是慢性肾脏疾病（CKD）和终末期肝病（ESLD）患者的最佳治疗方式。自从1983年第一次SLK移植以来,全世界的SLK移植数量不断增加,自2002年实施MELD系统以来，尤其是在美国。SLK移植被认为是一种相对较低的免疫风险程序，多项研究显示了肝脏对SLK受体免疫系统的免疫调节特性。与单独的肾移植受者相比，SLK受者对同种异体肾移植的细胞和抗体介导的排斥反应均较低。因此,在预先形成的供体特异性HLA抗体（DSA）的背景下进行SLK移植是一种常见的做法，在许多中心。SLK的接受和移植仅基于ABO兼容性，而无需过多考虑交叉匹配结果或DSA水平。然而,一些研究表明,在高水平的预先形成的HLADSA中,SLK受体的排斥反应风险增加.尽管如此,关于预先形成的DSA的可接受水平没有共识，移植前脱敏的作用，脾切除术,或免疫抑制管理在这个独特的人群。此外，在SLK受者中,移植后DSA监测对长期结局的影响尚未得到充分研究.在这篇文章中,我们回顾了该领域的最新和相关文章，重点是SLK接受者的免疫风险因素，以及减轻其中负面结果的策略。
