On-demand strategy as an alternative to conventionally scheduled post-transplant immunoadsorptions after ABO-incompatible kidney transplantation

• Published in: Nephrology, dialysis, transplantation Vol. 22; no. 10; pp. 3048 - 3051
• Main Authors: Wilpert, Jochen, Geyer, Marcel, Pisarski, Przemyslaw, Drognitz, Oliver, Schulz-Huotari, Christian, Gropp, Anette, Goebel, Heike, Gerke, Peter, Teschner, Sven, Walz, Gerd, Donauer, Johannes
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-10-2007; Oxford Publishing Limited (England)
• Subjects: ABO Blood-Group System; ABO-incompatible; Adsorption; Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Group Incompatibility; Emergency and intensive care: renal failure. Dialysis management; Female; Histocompatibility Testing; Humans; IgG titer; immunoadsorption; Immunoglobulin G - chemistry; Immunomodulators; Immunosorbent Techniques; Immunosuppressive Agents - therapeutic use; indirect antiglobulin test; Intensive care medicine; kidney transplantation; Kidney Transplantation - methods; Living Donors; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Risk; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; IgG titer; ABO-incompatible; immunoadsorption; kidney transplantation; indirect antiglobulin test; Kidney disease; Extrarenal dialysis; Urinary system disease; Hemodialysis; Renal failure; IgG
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfm460

Background. Since 2001, approximately 100 ABO-incompatible kidney transplantations have been performed in Europe. The standard protocol, employed by most transplant centres, uses rituximab and scheduled pre-emptive antigen-specific immunoadsorption on post-operative days 3, 6 and 9. Methods. Our centre has performed 22 ABO-incompatible kidney transplantations since 2004, using a different approach; like in Sweden, all patients received immunoadsorptions preoperatively, but instead of scheduling pre-emptive post-transplant immunoadsorptions, we submitted patients to immunoadsorptions post-operatively only, if their isoagglutinine titers (IgG-Anti-A or -B) exceeded certain thresholds. These thresholds were greater than 1 : 8 in the first post-operative week and greater than 1 : 16 in the second post-operative week, respectively. Results. A shorter pre-operative length on dialysis, a blood-type constellation of donor A1/recipient 0 and 9a high initial starting-titer were identified as predictors for post-operative immunoadsorptions. Conclusion. Using this on-demand strategy, our data reveal that a titer-dependent protocol reduces costs at no additional risk for the patient.