Preemptive postoperative antigen-specific immunoadsorption in ABO-incompatible kidney transplantation: necessary or not?
Several standard protocols for ABO-incompatible kidney transplantation use scheduled preemptive antigen-specific immunoadsorption during the postoperative period. Our center has developed a different approach. Our patients undergo antigen-specific immunoadsorption postoperatively only if their isoagglutinine titers (immunoglobulin G anti-A/B) exceed 1:8 in the first postoperative week and 1:16 in the second postoperative week. Using this strategy, 22 ABO-incompatible kidney transplantations have been performed at our center since 2004. Only 32% of these patients (7 of 22) needed to undergo postoperative immunoadsorption (mean 4.1 immunoadsorption sessions per patient). The renal outcome in patients receiving postoperative immunoadsorption treatment versus the outcome in patients without postoperative immunoadsorption remained equal at a mean follow-up of 17 months. We identified a shorter pretransplant time on dialysis, a blood type constellation of donor A1/recipient O, and high initial starting titers as predictors for the need for postoperative immunoadsorption treatment. A more detailed version of this study, with modified tables and figures, has been accepted for publication in Nephrology Dialysis Transplantation.
Geyer
Marcel
M
Renal Division, University Hospital Freiburg, Freiburg, Germany.
Donauer
Johannes
J
Pisarski
Przemyslaw
P
Drognitz
Oliver
O
Schulz-Huotari
Christian
C
Wisniewski
Ursula
U
Gropp
Anette
A
Göbel
Heike
H
Gerke
Peter
P
Teschner
Sven
S
Walz
Gerd
G
Wilpert
Jochen
J
D000017:ABO Blood-Group System; D000327:Adsorption; D000328:Adult; D000368:Aged; D000941:Antigens / Q000737:chemistry*; D001787:Blood Group Incompatibility; D005260:Female; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006801:Humans; D007074:Immunoglobulin G / Q000737:chemistry; D007164:Immunosorbents / Q000737:chemistry*; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome
D000017:ABO Blood-Group System; D000941:Antigens; D007074:Immunoglobulin G; D007164:Immunosorbents