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


CONCLUSIONS
Using this on-demand strategy, our data reveal that a titer-dependent protocol reduces costs at no additional risk for the patient.
Wilpert
Jochen
J
Renal Division, University Hospital Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany. jochen.wilpert@uniklinik-freiburg.de
Geyer
Marcel
M
Pisarski
Przemyslaw
P
Drognitz
Oliver
O
Schulz-Huotari
Christian
C
Gropp
Anette
A
Goebel
Heike
H
Gerke
Peter
P
Teschner
Sven
S
Walz
Gerd
G
Donauer
Johannes
J
D000017:ABO Blood-Group System; D000327:Adsorption; D000328:Adult; D000368:Aged; D001787:Blood Group Incompatibility; D005260:Female; D006650:Histocompatibility Testing; D006801:Humans; D007074:Immunoglobulin G / Q000737:chemistry; D007163:Immunosorbent Techniques; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012306:Risk
D000017:ABO Blood-Group System; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents