title: Anti-A/B antibody depletion by semiselective versus ABO blood group-specific immunoadsorption.
abstract: BACKGROUND
  Recipient desensitization using blood group (BG)-specific immunoadsorption (ABO-IA) has proven to enable successful kidney transplantation across major ABO barriers. In this context, the efficiency of non-antigen-specific (semiselective) IA adsorbers has not yet been established. The objective of our study was to quantify anti-A/B antibody depletion by protein A-, peptide ligand- and anti-human immunoglobulin-based semiselective IA in comparison to ABO-IA.
  
  
  METHODS
  Eight ABO-IA-treated transplant candidates and 39 patients subjected to semiselective IA for a variety of different indications outside the context of ABO-incompatible transplantation were included. Antibody patterns (IgG, IgG1-4 subclasses, IgM, C4d-fixing reactivities) were analysed applying conventional agglutination testing and flow cytometry.
  
  
  RESULTS
  As assessed by sensitive flow cytometric antibody detection, ABO-IA-based desensitization led to a profound even though often incomplete reduction of anti-A/B reactivities. Persistent complement- or non-complement-fixing reactivities, however, were not associated with transplant rejection or capillary C4d deposition. Single sessions of semiselective IA turned out to be more effective than ABO-IA in decreasing levels of anti-A/B IgG [median reduction to 28 versus 59% (ABO-IA) of baseline values, P < 0.001). In contrast, BG-specific IgM (74 versus 30%, P < 0.001) and IgG3 (72 versus 42%, P < 0.05) were reduced to a lesser extent, without differences between tested adsorber types. Analysis of four consecutive IA sessions revealed that inferior efficiency could not be overcome by serial treatment.
  
  
  CONCLUSIONS
  Our observation of limited adsorption capacities regarding distinct BG-specific Ig (sub)classes suggests caution in applying semiselective IA techniques in ABO-incompatible kidney transplantation.
authors.affiliation: Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
authors.forename: Markus
authors.initials: M
authors.lastname: Wahrmann
authors.forename: Martin
authors.initials: M
authors.lastname: Schiemann
authors.forename: Lena
authors.initials: L
authors.lastname: Marinova
authors.forename: Günther F
authors.initials: GF
authors.lastname: Körmöczi
authors.forename: Kurt
authors.initials: K
authors.lastname: Derfler
authors.forename: Thomas
authors.initials: T
authors.lastname: Fehr
authors.forename: Georg
authors.initials: G
authors.lastname: Stussi
authors.forename: Georg A
authors.initials: GA
authors.lastname: Böhmig
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000888:Antibodies, Anti-Idiotypic / Q000097:blood*; D001787:Blood Group Incompatibility / Q000276:immunology; D015935:Complement C4b; D003888:Desensitization, Immunologic / Q000379:methods*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007163:Immunosorbent Techniques; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D010446:Peptide Fragments / Q000097:blood; D011446:Prospective Studies
chemical_list: D000017:ABO Blood-Group System; D000888:Antibodies, Anti-Idiotypic; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D010446:Peptide Fragments; D015935:Complement C4b; C032261:complement C4d