title: The Reuse of Immunoadsorption Columns in ABO-Incompatible Kidney Transplantation Is Efficient: The Swiss Experience.
abstract: BACKGROUND
  We developed a multicentric Swiss protocol for ABO-incompatible kidney transplantation including immunoadsorption column reuse. The aim of this study was to assess efficacy and safety of immunoadsorption column reuse in ABO-incompatible kidney transplantation.
  
  
  METHODS
  We performed a multicentric prospective trial including all ABO-incompatible kidney transplantations in Switzerland from 2005 to 2011. Patients received rituximab and standardized immunosuppression with tacrolimus, mycophenolate mofetil, and steroids. Antigen-specific perioperative immunoadsorption was performed. Immunoadsorption columns were reused after restoration. Graft survival, patient survival, kidney function, rejections, number of columns, adverse events after column reuse, and anti-A/anti-B antibody titers were assessed.
  
  
  RESULTS
  Seventy-one ABO-incompatible patients underwent antigen-specific immunoadsorption and could be transplanted across the blood group barrier. Kaplan-Meier estimates for both, patient-censored and death-censored graft survivals were both 97.2% at 5 years. Allograft function was excellent with a mean estimated glomerular filtration rate of 54 mL per min after 1 year. The median number of pretransplant immunoadsorptions was 5. All centers performed column reuse. A total of 394 immunoadsorption procedures were performed with reused filters. Patient survival, graft survival, and adverse events did not differ when filters were reused. Column reuse resulted in cost savings of 21,458 USD per patient.
  
  
  CONCLUSIONS
  We have introduced a national protocol for ABO-incompatible kidney transplantation including immunoadsorption column reuse. Column reuse was efficient and safe.
authors.affiliation: 1 Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland. 2 Department of Nephrology, University Hospital Bern, Bern, Switzerland. 3 Department of Nephrology, University Hospital Geneva, Geneva, Switzerland. 4 Department of Nephrology, Kantonsspital St. Gallen, St. Gallen, Switzerland. 5 Department of Nephrology, University Hospital Zurich, Zurich, Switzerland. 6 Department of Nephrology, University Hospital Basel, Basel, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Schiesser
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Steinemann
authors.forename: Karine
authors.initials: K
authors.lastname: Hadaya
authors.forename: Uyen
authors.initials: U
authors.lastname: Huynh-Do
authors.forename: Ute
authors.initials: U
authors.lastname: Eisenberger
authors.forename: Isabelle
authors.initials: I
authors.lastname: Binet
authors.forename: Thomas
authors.initials: T
authors.lastname: Fehr
authors.forename: Michael
authors.initials: M
authors.lastname: Dickenmann
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D000368:Aged; D000906:Antibodies / Q000097:blood; D001787:Blood Group Incompatibility / Q000276:immunology*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival; D006801:Humans; D007163:Immunosorbent Techniques; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D000017:ABO Blood-Group System; D000906:Antibodies