title: Treatment of large plasma volumes using specific immunoadsorption to desensitize ABO-incompatible kidney-transplant candidates.
abstract: BACKGROUND
  ABO-incompatible (ABOi) kidney-transplantation has very good long-term results, i.e. similar to those observed for living-kidney ABO-compatible transplantation. This is because patients are desensitized at pretransplant using apheresis and rituximab therapy, with tacrolimus-based immunosuppression.
  
  
  OBJECTIVE
  To assess the efficacy of a single, pretransplant (Day -1), specific immunoadsorption session using Glycosorb® columns (anti-A or anti-B; Glycorex Sweden) to treat large volumes of plasma (up to 18 L).
  
  
  METHODS
  Prospective single-center study evaluating 12 consecutive patients (6 males), aged 40 (23-59) years. Incompatibilities were A into 0 (8), B into 0 (3), and AB into 0 (1). Pretransplant desensitization relied on rituximab (D-30), tacrolimus, mycophenolic acid, and steroids (all started on D-13), and a single session of specific immunoadsorption on D-1. Immunoadsorption was coupled in tandem with a hemodialysis session.
  
  
  RESULTS
  Overall, 15 L (11-18) of plasma were treated per patient, i.e., 0.2 (0.11-0.36 L/kg). Isoagglutinin titers were 1/16 (1/5-1/64) before the procedure, decreasing after 6 hours to 1/5 (1/1-1/16 P = 0.008), and to 1/2 (1/1-1/8; P = 0.05) at completion of the session. The next day, i.e., the day of transplantation, there was no rebound of isoagglutinins [1/4 (1/1-1/5); P = ns]. The procedure was well tolerated with no side-effects and no significant changes in hemoglobin level, platelet counts, fibrinogen, or albumin levels.
  
  
  CONCLUSIONS
  For ABOi kidney-transplantation, a single, longer, specific immunoadsorption session was very efficient at 1-day pre-transplantation with no rebound. These results should be confirmed when isoagglutinin titers are higher (≥120).
authors.affiliation: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France ; INSERM U563, IFR-BMT, CHU Purpan, Toulouse, France ; Université Toulouse III Paul Sabatier, Toulouse, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Rostaing
authors.affiliation: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.
authors.forename: Asma
authors.initials: A
authors.lastname: Allal
authors.affiliation: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Del Bello
authors.affiliation: Department of Urology, Andrology, and Transplantation, CHU Rangueil, Toulouse, France.
authors.forename: Federico
authors.initials: F
authors.lastname: Sallusto
authors.affiliation: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Esposito
authors.affiliation: Department of Urology, Andrology, and Transplantation, CHU Rangueil, Toulouse, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Doumerc
authors.affiliation: Etablissement Français du Sang de Midi-Pyrénées, CHU Purpan, Toulouse, France.
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Debiol
authors.affiliation: Laboratory of Histopathology, CHU Rangueil, Toulouse, France.
authors.forename: Audrey
authors.initials: A
authors.lastname: Delas
authors.affiliation: Université Toulouse III Paul Sabatier, Toulouse, France ; Department of Urology, Andrology, and Transplantation, CHU Rangueil, Toulouse, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Game
authors.affiliation: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France ; Université Toulouse III Paul Sabatier, Toulouse, France ; INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France.
authors.forename: Nassim
authors.initials: N
authors.lastname: Kamar
keywords: ABO-incompatible kidney transplantation; Glycosorb®; Large plasma volumes; Specific immunoadsorption