On-demand strategy as an alternative to conventionally scheduled post-transplant immunoadsorptions after ABO-incompatible kidney transplantation

Nephrol Dial Transplant. 2007 Oct;22(10):3048-51. doi: 10.1093/ndt/gfm460. Epub 2007 Jul 10.

Abstract

Background: Since 2001, approximately 100 ABO-incompatible kidney transplantations have been performed in Europe. The standard protocol, employed by most transplant centres, uses rituximab and scheduled pre-emptive antigen-specific immunoadsorption on post-operative days 3, 6 and 9.

Methods: Our centre has performed 22 ABO-incompatible kidney transplantations since 2004, using a different approach; like in Sweden, all patients received immunoadsorptions preoperatively, but instead of scheduling pre-emptive post-transplant immunoadsorptions, we submitted patients to immunoadsorptions post-operatively only, if their isoagglutinine titers (IgG-Anti-A or -B) exceeded certain thresholds. These thresholds were greater than 1 : 8 in the first post-operative week and greater than 1 : 16 in the second post-operative week, respectively.

Results: A shorter pre-operative length on dialysis, a blood-type constellation of donor A1/recipient 0 and 9a high initial starting-titer were identified as predictors for post-operative immunoadsorptions.

Conclusion: Using this on-demand strategy, our data reveal that a titer-dependent protocol reduces costs at no additional risk for the patient.

MeSH terms

  • ABO Blood-Group System*
  • Adsorption
  • Adult
  • Aged
  • Blood Group Incompatibility*
  • Female
  • Histocompatibility Testing*
  • Humans
  • Immunoglobulin G / chemistry
  • Immunosorbent Techniques
  • Immunosuppressive Agents / therapeutic use*
  • Kidney Transplantation / methods*
  • Living Donors
  • Male
  • Middle Aged
  • Risk

Substances

  • ABO Blood-Group System
  • Immunoglobulin G
  • Immunosuppressive Agents