title: ABO-incompatible kidney transplantation using regenerative selective immunoglobulin adsorption.
abstract: BACKGROUND
  ABO-incompatible (ABOi) kidney transplantation is an established procedure relying on the removal of donor-specific isoagglutinine antibodies as part of the recipient preconditioning. At present, current protocols using immunoadsorption apply a single-use selective carbohydrate isoagglutinine adsorber. A regenerative and selective immunoglobulin immunoadsorption could be an alternative but has not been reported for ABOi transplantation.
  
  
  METHODS
  Eight patients were treated with the commonly used isoagglutinine carbohydrate epitope adsorber and seven with a regenerative polyclonal sheep anti-immunoglobulin adsorber as part of the preconditioning for ABOi kidney transplantation. An IgG-isoagglutinine titer of less or equal 1:4 qualified for transplantation. Treatment safety, efficiency, length of desensitization, number of postoperative immunoadsorptions, and allograft outcome were retrospectively compared.
  
  
  RESULTS
  With the use of the immunoglobulin adsorber the median initial isoagglutinine IgG titers of 1:64 (range 1:32-1:256) were lowered to the target of 1:4 preoperatively with a mean of 6.2 immunoadsorptions (range 5-11). Mean IgG/IgM titer step reduction per IA was 1.98/1.21 for (range 0-4/0-4) and mean titer step rebound 1.31/0.82 (range 0-4/0-3), respectively. The number of immunoadsorptions and length of desensitization was not different from the use of the specific isoagglutinine adsorbers. After transplantation, no rejection occurred and only one postoperative immunoadsorption was necessary. No adverse events in relation to immunoadsorption were observed. Graft function was comparable to the isoagglutinine adsorber group.
  
  
  CONCLUSIONS
  These data suggest that ABOi kidney transplantation can be performed safely and effectively with a selective regenerative immunoglobulin immunoadsorber.
authors.affiliation: Transplant Center Cologne, University Hospital Cologne, Cologne, Germany. steschner@me.com
authors.forename: Sven
authors.initials: S
authors.lastname: Teschner
authors.forename: Dirk
authors.initials: D
authors.lastname: Stippel
authors.forename: Roland
authors.initials: R
authors.lastname: Grunenberg
authors.forename: Bodo
authors.initials: B
authors.lastname: Beck
authors.forename: Roger
authors.initials: R
authors.lastname: Wahba
authors.forename: Birgit
authors.initials: B
authors.lastname: Gathof
authors.forename: Thomas
authors.initials: T
authors.lastname: Benzing
authors.forename: Volker
authors.initials: V
authors.lastname: Burst
mesh_terms: D000017:ABO Blood-Group System; D000327:Adsorption; D000328:Adult; D001781:Blood Component Removal / Q000379:methods*; D001787:Blood Group Incompatibility; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000737:chemistry; D007136:Immunoglobulins / Q000737:chemistry*; D007163:Immunosorbent Techniques; D016030:Kidney Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange
chemical_list: D000017:ABO Blood-Group System; D007074:Immunoglobulin G; D007136:Immunoglobulins