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Nephrol Dial Transplant. 2007 Oct;22(10):3048-51. Epub 2007 Jul 10.

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

Author information

1
Renal Division, University Hospital Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany. jochen.wilpert@uniklinik-freiburg.de

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.

Comment in

PMID:
17623716
DOI:
10.1093/ndt/gfm460
[Indexed for MEDLINE]

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