title: ABO-incompatible kidney transplantation enabled by non-antigen-specific immunoadsorption.
abstract: BACKGROUND
  ABO-incompatible kidney transplantation performed after desensitization with antigen-specific immunoadsorption (IA) results in good outcomes. However, a unique single-use IA device is required, which creates high costs.
  
  
  METHODS
  From August 2005 to August 2010, 19 patients were desensitized for ABO-incompatible living donor kidney transplantation. Six patients treated with a single-use antigen-specific IA device and 12 patients treated with a reusable non-antigen-specific IA device were analyzed.
  
  
  RESULTS
  Six patients who received antigen-specific IA had a median of 5 IA treatments and 12 patients with non-antigen-specific IA had a median of 6 IA treatments preoperatively. Median average titer drop in Coombs technique was 1.2 in antigen-specific IA and 1.7 in non-antigen-specific IA. In two patients with antigen-specific IA and four patients with non-antigen-specific IA, additional plasmapheresis treatments were necessary for recipient desensitization. Despite six treatments with antigen-specific IA and 12 plasmapheresis treatments, one patient with a starting isoagglutinin titer of 1:1024 (Coombs) could not be transplanted. The 18-month graft survival rate for the 17 ABO-incompatible living donor kidney transplants was 100%. One male recipient who was desensitized with antigen-specific IA died 44 months after transplantation from sudden cardiac death with a serum creatinine of 1.2 mg/dL. At last follow-up, a median of 13 months after transplantation, median serum creatinine for 16 patients was 1.5 mg/dL, median glomerular filtration rate as estimated by the modification of diet in renal disease formula 54 mL/min/1.73 m, and median urinary protein-to-creatinine ratio 0.1, with no differences between treatments.
  
  
  CONCLUSIONS
  A reusable non-antigen-specific IA device allows high number of treatments at reasonable cost, and at the same time might deplete human leukocyte antigen-alloantibodies.
authors.affiliation: Department of Nephrology, University of Heidelberg, Heidelberg, Germany. christian.morath@med.uni-heidelberg.de
authors.forename: Christian
authors.initials: C
authors.lastname: Morath
authors.forename: Luis Eduardo
authors.initials: LE
authors.lastname: Becker
authors.forename: Albrecht
authors.initials: A
authors.lastname: Leo
authors.forename: Jörg
authors.initials: J
authors.lastname: Beimler
authors.forename: Katrin
authors.initials: K
authors.lastname: Klein
authors.forename: Jörg
authors.initials: J
authors.lastname: Seckinger
authors.forename: Lars Philipp
authors.initials: LP
authors.lastname: Kihm
authors.forename: Peter
authors.initials: P
authors.lastname: Schemmer
authors.forename: Stephan
authors.initials: S
authors.lastname: Macher-Goeppinger
authors.forename: Markus
authors.initials: M
authors.lastname: Wahrmann
authors.forename: Georg A
authors.initials: GA
authors.lastname: Böhmig
authors.forename: Gerhard
authors.initials: G
authors.lastname: Opelz
authors.forename: Caner
authors.initials: C
authors.lastname: Süsal
authors.forename: Martin
authors.initials: M
authors.lastname: Zeier
authors.forename: Vedat
authors.initials: V
authors.lastname: Schwenger
mesh_terms: D000328:Adult; D001787:Blood Group Incompatibility / Q000276:immunology*; D003404:Creatinine / Q000097:blood / Q000652:urine; D005260:Female; D005919:Glomerular Filtration Rate; D006085:Graft Survival / Q000276:immunology; D006801:Humans; D007163:Immunosorbent Techniques; D016030:Kidney Transplantation / Q000191:economics / Q000276:immunology*; D008297:Male; D008875:Middle Aged
chemical_list: D003404:Creatinine