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ABO-incompatible kidney transplantation enabled by Non-Antigen-Specific immunoadsorption

Background. ABO-incompatible kidney transplantation performed after desensitization with antigen-specific immunoadsorption (IA) results in good outcomes. However, a unique single-use IA device is required, which creates high costs. Methods. From August 2005 to August 2010, 19 patients were desensiti...

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Main Authors: Morath, Christian (Author) , Becker, Luis Eduardo (Author) , Leo, Albrecht (Author) , Beimler, Jörg (Author) , Klein, Katrin (Author) , Seckinger, Jörg (Author) , Kihm, Lars Philipp (Author) , Schemmer, Peter (Author) , Macher-Göppinger, Stephan (Author) , Opelz, Gerhard (Author) , Süsal, Caner (Author) , Zeier, Martin (Author) , Schwenger, Vedat (Author)
Format: Article (Journal)
Language:English
Published: April 27, 2012
In: Transplantation
Year: 2012, Volume: 93, Issue: 8, Pages: 827-834
ISSN:1534-6080
DOI:10.1097/TP.0b013e31824836ae
Online Access:Verlag, Volltext: http://dx.doi.org/10.1097/TP.0b013e31824836ae
Verlag, Volltext: https://journals.lww.com/transplantjournal/Fulltext/2012/04270/ABO_Incompatible_Kidney_Transplantation_Enabled_by.12.aspx
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Author Notes:Christian Morath, Luis Eduardo Becker, Albrecht Leo, Jörg Beimler, Katrin Klein, Jörg Seckinger, Lars Philipp Kihm, Peter Schemmer, Stephan Macher-Goeppinger, Markus Wahrmann, Georg A. Böhmig, Gerhard Opelz, Caner Süsal, Martin Zeier, Vedat Schwenger
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Summary:Background. ABO-incompatible kidney transplantation performed after desensitization with antigen-specific immunoadsorption (IA) results in good outcomes. However, a unique single-use IA device is required, which creates high costs. Methods. From August 2005 to August 2010, 19 patients were desensitized for ABO-incompatible living donor kidney transplantation. Six patients treated with a single-use antigen-specific IA device and 12 patients treated with a reusable non-antigen-specific IA device were analyzed. Results. Six patients who received antigen-specific IA had a median of 5 IA treatments and 12 patients with non-antigen-specific IA had a median of 6 IA treatments preoperatively. Median average titer drop in Coombs technique was 1.2 in antigen-specific IA and 1.7 in non-antigen-specific IA. In two patients with antigen-specific IA and four patients with non-antigen-specific IA, additional plasmapheresis treatments were necessary for recipient desensitization. Despite six treatments with antigen-specific IA and 12 plasmapheresis treatments, one patient with a starting isoagglutinin titer of 1:1024 (Coombs) could not be transplanted. The 18-month graft survival rate for the 17 ABO-incompatible living donor kidney transplants was 100%. One male recipient who was desensitized with antigen-specific IA died 44 months after transplantation from sudden cardiac death with a serum creatinine of 1.2 mg/dL. At last follow-up, a median of 13 months after transplantation, median serum creatinine for 16 patients was 1.5 mg/dL, median glomerular filtration rate as estimated by the modification of diet in renal disease formula 54 mL/min/1.73 m2, and median urinary protein-to-creatinine ratio 0.1, with no differences between treatments. Conclusions. A reusable non-antigen-specific IA device allows high number of treatments at reasonable cost, and at the same time might deplete human leukocyte antigen-alloantibodies.
Item Description:Gesehen am 07.05.2018
Physical Description:Online Resource
ISSN:1534-6080
DOI:10.1097/TP.0b013e31824836ae

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