Abstract
ABO-incompatible (ABOi) kidney-transplantation has very good long-term results, i.e. similar to those observed for living-kidney ABO-compatible transplantation. This is because patients are desensitized at pretransplant using apheresis and rituximab therapy, with tacrolimus-based immunosuppression. To assess the efficacy of a single, pretransplant (Day -1), specific immunoadsorption session using Glycosorb® columns (anti-A or anti-B; Glycorex Sweden) to treat large volumes of plasma (up to 18 L). Prospective single-center study evaluating 12 consecutive patients (6 males), aged 40 (23-59) years. Incompatibilities were A into 0 (8), B into 0 (3), and AB into 0 (1). Pretransplant desensitization relied on rituximab (D-30), tacrolimus, mycophenolic acid, and steroids (all started on D-13), and a single session of specific immunoadsorption on D-1. Immunoadsorption was coupled in tandem with a hemodialysis session. Overall, 15 L (11-18) of plasma were treated per patient, i.e., 0.2 (0.11-0.36 L/kg). Isoagglutinin titers were 1/16 (1/5-1/64) before the procedure, decreasing after 6 hours to 1/5 (1/1-1/16 P = 0.008), and to 1/2 (1/1-1/8; P = 0.05) at completion of the session. The next day, i.e., the day of transplantation, there was no rebound of isoagglutinins [1/4 (1/1-1/5); P = ns]. The procedure was well tolerated with no side-effects and no significant changes in hemoglobin level, platelet counts, fibrinogen, or albumin levels. For ABOi kidney-transplantation, a single, longer, specific immunoadsorption session was very efficient at 1-day pre-transplantation with no rebound. These results should be confirmed when isoagglutinin titers are higher (≥120).
Highlights
ABO-incompatible (ABOi) kidney-transplantation has very good long-term results, i.e. similar to those observed for living-kidney ABO-compatible transplantation
In this study we demonstrate that using a single specific immunoadsorption column with treating large plasma volumes is very efficient, is associated with no isoagglutinin rebound and thereby might reduce dramatically the cost of ABOi desensitization
Worldwide, many people suffer from end-stage renal disease (ESRD), of which about a third are eligible for kidney transplantation
Summary
ABO-incompatible (ABOi) kidney-transplantation has very good long-term results, i.e. similar to those observed for living-kidney ABO-compatible transplantation. Conclusions: For ABOi kidney-transplantation, a single, longer, specific immunoadsorption session was very efficient at 1-day pre-transplantation with no rebound These results should be confirmed when isoagglutinin titers are higher (≥120). We hypothesized that treating high plasma volumes (≈15 to 20 L per session) within a single session could be efficient with regards to isoagglutinin titers and would not cause isoagglutinin rebound. This would result in a large decrease in the number of columns needed per patient. In order to demonstrate this, we included 12 patients whose isoagglutinin titers were not too high prior to desensitization, i.e., lower than 1/64
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