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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| Hauptverfasser: | , , , , , , , , , , , , , |
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| Dokumenttyp: | Article (Journal) |
| Sprache: | Englisch |
| Veröffentlicht: |
11 January 2015
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| In: |
Transplantation
Year: 2015, Jahrgang: 99, Heft: 11, Pages: 2364-2371 |
| ISSN: | 1534-6080 |
| DOI: | 10.1097/TP.0000000000000753 |
| Online-Zugang: | 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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| Verfasserangaben: | 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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| 245 | 1 | 0 | |a Outcomes following ABO-incompatible kidney transplantation performed after desensitization by nonantigen-specific immunoadsorption |c 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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| 520 | |a 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. | ||
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