title: ABO-incompatible kidney transplant recipients have a higher bleeding risk after antigen-specific immunoadsorption.
abstract: Pretransplant removal of antiblood group ABO antibodies is the cornerstone of all current ABO-incompatible (ABOi) transplantation programmes. In our protocol, plasmapheresis (PP) is performed with a plasmafilter followed by immunoadsorption (IA) of anti-ABO antibodies. The bleeding complications of this technique are not known. We analysed the data of all 65 consecutive ABOi kidney transplantations between March 2006 and October 2013 and compared these with matched 130 ABO-compatible (ABOc) kidney transplantations. Cases differed from controls in the pre-operative regimen, which included IA-PP and rituximab, tacrolimus, mycophenolate mofetil, prednisone and immunoglobulines. Data on platelet count, blood loss and red blood cell (EC) transfusions during 48 h postoperatively were collected. ABOi patients received EC transfusions more frequently than controls (29% vs. 12%, P = 0.005). Intra-operative blood loss was higher (544 vs. 355 ml, P < 0.005) and they experienced more major bleeding (≥3 EC within 24 h, 15% vs. 2%, P < 0.0005). Platelet count decreased by 28% after the pre-operative IA. In a multivariate model, only the number of pre-operative IAs was associated with the number of ECs given (OR per IA 1.9, P < 0.05). ABOi kidney transplant recipients have a high postoperative bleeding risk, correlating with the number of pre-operative IA sessions performed.
authors: Department of Nephrology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Annelies E
authors: AE
authors: de Weerd
authors: Madelon
authors: M
authors: van Agteren
authors: Frank W
authors: FW
authors: Leebeek
authors: Jan N M
authors: JN
authors: Ijzermans
authors: Willem
authors: W
authors: Weimar
authors: Michiel G H
authors: MG
authors: Betjes
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000906:Antibodies / Q000737:chemistry; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000941:Antigens / Q000737:chemistry*; D001787:Blood Group Incompatibility; D016022:Case-Control Studies; D015331:Cohort Studies; D017707:Erythrocyte Transfusion; D005260:Female; D006470:Hemorrhage; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage; D007166:Immunosuppressive Agents / Q000737:chemistry; D007676:Kidney Failure, Chronic / Q000276:immunology / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives; D010976:Platelet Count; D011241:Prednisone / Q000008:administration & dosage; D000069283:Rituximab; D016559:Tacrolimus / Q000008:administration & dosage
chemical_list: D000017:ABO Blood-Group System; D000906:Antibodies; D058846:Antibodies, Monoclonal, Murine-Derived; D000941:Antigens; D007136:Immunoglobulins; D007166:Immunosuppressive Agents; D000069283:Rituximab; D009173:Mycophenolic Acid; D011241:Prednisone; D016559:Tacrolimus
keywords: ABO-incompatible kidney transplantation; blood transfusion; immunoadsorption; plasmapheresis