title: Outcomes Following ABO-Incompatible Kidney Transplantation Performed After Desensitization by Nonantigen-Specific Immunoadsorption.
abstract: BACKGROUND
  For desensitization of ABO-incompatible kidney transplant recipients we recently proposed nonantigen-specific immunoadsorption (IA) and rituximab.
  
  
  METHODS
  We now compared clinical outcomes of 34 ABO-incompatible living-donor kidney recipients who were transplanted using this protocol with that of 68 matched ABO-compatible patients. In addition, we analyzed efficacy and cost of nonantigen-specific as compared to blood group antigen-specific IA.
  
  
  RESULTS
  Before desensitization, the median isoagglutinin titer of 34 ABO-incompatible patients was 1:64 (Coombs technique). Patients received a median of 7 preoperative IA treatments. Twenty-four patients had a median of 2 additional plasmapheresis treatments to reach the preoperative target isoagglutinin titer of 1:8 or less. After a median postoperative follow-up of 22 months, overall graft survival in the ABO-incompatible group was not significantly different from that in ABO-compatible patients (log-rank P = 0.20), whereas patient survival tended to be lower (log-rank P = 0.05). The incidence of rejection episodes was 15% in both groups. The ABO-incompatible kidney recipients had a higher incidence of BK virus replication (P = 0.04) and nephropathy (P = 0.01) and showed more often colonization with multidrug resistant bacteria (P = 0.02). In comparison to blood group antigen-specific IA, nonantigen-specific IA showed equal efficacy but was associated with reduction in cost.
  
  
  CONCLUSIONS
  Clinical outcomes of ABO-incompatible patients desensitized with a nonantigen-specific IA device and rituximab do not differ from that of matched ABO-compatible patients although a trend toward reduced patient survival was noted. Special attention must be paid to the higher incidence of BK virus infection in recipients of ABO-incompatible grafts.
authors.affiliation: 1 Division of Nephrology, University of Heidelberg, Heidelberg, Germany. 2 Department of Transplantation Immunology, University of Heidelberg, Heidelberg, Germany. 3 Institute for Clinical Transfusion Medicine and Cell Therapy Heidelberg, University of Heidelberg, Heidelberg, Germany. 4 Institute of Pathology, University of Heidelberg, Heidelberg, Germany. 5 Division of Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
authors.forename: Luis E
authors.initials: LE
authors.lastname: Becker
authors.forename: Daniela
authors.initials: D
authors.lastname: Siebert
authors.forename: Caner
authors.initials: C
authors.lastname: Süsal
authors.forename: Gerhard
authors.initials: G
authors.lastname: Opelz
authors.forename: Albrecht
authors.initials: A
authors.lastname: Leo
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Waldherr
authors.forename: Stephan
authors.initials: S
authors.lastname: Macher-Goeppinger
authors.forename: Peter
authors.initials: P
authors.lastname: Schemmer
authors.forename: Sebastian Markus
authors.initials: SM
authors.lastname: Schaefer
authors.forename: Katrin
authors.initials: K
authors.lastname: Klein
authors.forename: Jörg
authors.initials: J
authors.lastname: Beimler
authors.forename: Martin
authors.initials: M
authors.lastname: Zeier
authors.forename: Vedat
authors.initials: V
authors.lastname: Schwenger
authors.forename: Christian
authors.initials: C
authors.lastname: Morath
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001739:BK Virus / Q000276:immunology / Q000472:pathogenicity; D001787:Blood Group Incompatibility / Q000097:blood / Q000175:diagnosis / Q000276:immunology*; D003362:Cost-Benefit Analysis; D003888:Desensitization, Immunologic / Q000009:adverse effects / Q000191:economics / Q000379:methods* / Q000401:mortality; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival; D017048:Health Care Costs; D006648:Histocompatibility; D006650:Histocompatibility Testing; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D027601:Polyomavirus Infections / Q000276:immunology / Q000821:virology; D012307:Risk Factors; D000069283:Rituximab / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D014412:Tumor Virus Infections / Q000276:immunology / Q000821:virology; D055815:Young Adult
chemical_list: D000017:ABO Blood-Group System; D007166:Immunosuppressive Agents; D000069283:Rituximab