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Transplantation. 2015 Nov;99(11):2364-71. doi: 10.1097/TP.0000000000000753.

Outcomes Following ABO-Incompatible Kidney Transplantation Performed After Desensitization by Nonantigen-Specific Immunoadsorption.

Author information

1
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.

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.

PMID:
25989497
DOI:
10.1097/TP.0000000000000753
[Indexed for MEDLINE]

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