Immune tolerance promotion by the liver in simultaneous liver kidney transplantation

Chronic alloimmune-mediated injury in kidney transplantation continues to elude effective treatment and negatively impact outcomes. With increased utilization of simultaneous liver and kidney transplants (SLK), many have observed that these recipients have improved kidney graft survival when compared to kidney alone recipients. This intriguing observation has incited a growing group of studies that aim to elucidate the mechanisms behind the liver allograft's ability to modulate recipient's alloimmune responses against the kidney allograft. In this article, we will provide a brief overview of donor specific antibodies (DSA)-mediated injury of kidney allograft, the impact of SLK on recipients with pre-existing DSA, and current theorized pathways through which the liver allograft confers immune tolerance.