title: Antigen-Specific versus Non-Antigen-Specific Immunoadsorption in ABO-Incompatible Renal Transplantation.
abstract: BACKGROUND
  ABO-incompatible (ABOi) renal transplantation (RTx) from living donors is an established procedure to expand the donor pool for patients with end stage renal disease. Immunoadsorption (IA) is a standard procedure for the removal of preformed antibodies against the allograft. In this study, antigen-specific and non-antigen-specific IA in ABOi RTx were compared.
  
  
  METHODS
  10 patients underwent antigen-specific IA (Glycosorb group) and 13 patients non-antigen-specific IA (Immunosorba group). The effects of both procedures regarding antibody reduction, number of treatments, complications, costs, as well as the allograft function and patient survival were compared between both groups.
  
  
  RESULTS
  Although the IgG levels were reduced equally by both procedures (p=0.82), the reduction of the IgM level was more effective in the Glycosorb group (p=0.0172). Patients in both groups required a median number of 6 IA before ABOi RTx. Allograft function at one year after AB0i RTx was similar in both groups (estimated glomerular filtration rate: 66 vs. 64 ml/min/1.73m² respectively), with a death-censored graft survival of 90.0% and 92.3% respectively. Complication rates did not differ between procedures. Due to the reuse of non-antigen-specific Immunosorba columns, costs were considerably lower in this group; however, the use of the Immunosorba-based IA was less time-efficient.
  
  
  CONCLUSIONS
  Considering upcoming alternatives as simultaneous performance of dialysis and IA or a possible reuse of Glycosorb columns, this might become less relevant in the future.
authors.affiliation: Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, Münster, Germany.
authors.forename: Gerold
authors.initials: G
authors.lastname: Thölking
authors.affiliation: Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany.
authors.forename: Raphael
authors.initials: R
authors.lastname: Koch
authors.affiliation: Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, Münster, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Pavenstädt
authors.affiliation: Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, Münster, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Schuette-Nuetgen
authors.affiliation: Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, Münster, Germany.
authors.forename: Veit
authors.initials: V
authors.lastname: Busch
authors.affiliation: Department of General Surgery, University Hospital of Münster, Münster, Germany.
authors.forename: Heiner
authors.initials: H
authors.lastname: Wolters
authors.affiliation: Institute of Transfusion Medicine and Transplantation Immunology, University Hospital of Münster, Münster, Germany.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kelsch
authors.affiliation: Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, Münster, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Reuter
authors.affiliation: Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital of Münster, Münster, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Suwelack
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D000368:Aged; D001706:Biopsy; D000939:Epitopes / Q000276:immunology*; D005260:Female; D006648:Histocompatibility; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology; D007075:Immunoglobulin M / Q000276:immunology; D007163:Immunosorbent Techniques; D007165:Immunosuppression Therapy; D007668:Kidney / Q000473:pathology; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D011183:Postoperative Complications / Q000209:etiology; D055815:Young Adult
chemical_list: D000017:ABO Blood-Group System; D000939:Epitopes; D007074:Immunoglobulin G; D007075:Immunoglobulin M