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Outcomes following ABO-incompatible kidney transplantation performed after desensitization by nonantigen-specific immunoadsorption

Background - For desensitization of ABO-incompatible kidney transplant recipients we recently proposed nonantigen-specific immunoadsorption (IA) and rituximab. - Methods - We now compared clinical outcomes of 34 ABO-incompatible living-donor kidney recipients who were transplanted using this proto...

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Main Authors: Becker, Luis Eduardo (Author) , Siebert, Daniela (Author) , Süsal, Caner (Author) , Opelz, Gerhard (Author) , Leo, Albrecht (Author) , Waldherr, Rüdiger (Author) , Macher-Göppinger, Stephan (Author) , Schemmer, Peter (Author) , Schäfer, Sebastian Markus (Author) , Klein, Katrin (Author) , Beimler, Jörg (Author) , Zeier, Martin (Author) , Schwenger, Vedat (Author) , Morath, Christian (Author)
Format: Article (Journal)
Language:English
Published: 11 January 2015
In: Transplantation
Year: 2015, Volume: 99, Issue: 11, Pages: 2364-2371
ISSN:1534-6080
DOI:10.1097/TP.0000000000000753
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1097/TP.0000000000000753
Verlag, lizenzpflichtig, Volltext: https://journals.lww.com/transplantjournal/Fulltext/2015/11000/Outcomes_Following_ABO_Incompatible_Kidney.24.aspx
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Author Notes:Luis E. Becker, Daniela Siebert, Caner Süsal, Gerhard Opelz, Albrecht Leo, Rüdiger Waldherr, Stephan Macher-Goeppinger, Peter Schemmer, Sebastian Markus Schaefer, Katrin Klein, Jörg Beimler, Martin Zeier, Vedat Schwenger, and Christian Morath
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Summary:Background - For desensitization of ABO-incompatible kidney transplant recipients we recently proposed nonantigen-specific immunoadsorption (IA) and rituximab. - Methods - We now compared clinical outcomes of 34 ABO-incompatible living-donor kidney recipients who were transplanted using this protocol with that of 68 matched ABO-compatible patients. In addition, we analyzed efficacy and cost of nonantigen-specific as compared to blood group antigen-specific IA. -Results - Before desensitization, the median isoagglutinin titer of 34 ABO-incompatible patients was 1:64 (Coombs technique). Patients received a median of 7 preoperative IA treatments. Twenty-four patients had a median of 2 additional plasmapheresis treatments to reach the preoperative target isoagglutinin titer of 1:8 or less. After a median postoperative follow-up of 22 months, overall graft survival in the ABO-incompatible group was not significantly different from that in ABO-compatible patients (log-rank P = 0.20), whereas patient survival tended to be lower (log-rank P = 0.05). The incidence of rejection episodes was 15% in both groups. The ABO-incompatible kidney recipients had a higher incidence of BK virus replication (P = 0.04) and nephropathy (P = 0.01) and showed more often colonization with multidrug resistant bacteria (P = 0.02). In comparison to blood group antigen-specific IA, nonantigen-specific IA showed equal efficacy but was associated with reduction in cost. - Conclusions - Clinical outcomes of ABO-incompatible patients desensitized with a nonantigen-specific IA device and rituximab do not differ from that of matched ABO-compatible patients although a trend toward reduced patient survival was noted. Special attention must be paid to the higher incidence of BK virus infection in recipients of ABO-incompatible grafts.
Item Description:Gesehen am 04.08.2020
Physical Description:Online Resource
ISSN:1534-6080
DOI:10.1097/TP.0000000000000753

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