In:
Therapeutic Apheresis and Dialysis, Wiley, Vol. 19, No. 5 ( 2015-10), p. 513-517
Abstract:
After ABO ‐incompatible kidney transplantation, postoperative plasma exchange ( PE ) or immunoadsorption ( IA ) is performed per protocol or depending on postoperative A / B ‐titers to prevent acute rejection. However, the need for postoperative PE or IA is not known. Since 2006, 30 consecutive patients received three standard postoperative IAs . Starting from 2009, the last 46 patients received only preoperative IA . Preoperative desensitization consisted of rituximab, tacrolimus, mycophenolate mofetil, prednisone and intravenous immunoglobulins. Antigen‐specific IA was performed pre‐operatively with the Glycosorb device. Biopsy‐proven acute rejections either antibody‐mediated ( AMR ) or mixed cellular and antibody‐mediated ( MAR ) within 3 months were recorded. The postoperative titer in patients with postoperative IA did not exceed 1:16 ( IgG 1:4 [ 〈 2–16] median and range). The postoperative IgG titer was not significantly different after abandoning postoperative IA , although three patients had titers of 1:32 and one patient even 1:128. Rejections tended to be more frequent in the group with postoperative IA : 6 AMR and 3 MAR were recorded in 30 patients, vs. 4 AMR and 1 MAR in the 46 patients without postoperative IA (30 vs. 11%, P = 0.067). Baseline characteristics differed however: in the group with postoperative IA the vast majority had blood group O (87 vs. 52%, P = 0.003). Also, the IgG titer on the day of transplantation was higher (1:4 [ 〈 2–16] vs. 1:2 [ 〈 2–32], P = 0.007). All 14 patients with AMR and MAR rejections had postoperative IgG titers ≤1:16. Postoperative removal of A/ B ‐antibodies can be safely removed from the ABOi transplantation protocol using strict preoperative criteria for antibody lowering.
Type of Medium:
Online Resource
ISSN:
1744-9979
,
1744-9987
DOI:
10.1111/tap.2015.19.issue-5
DOI:
10.1111/1744-9987.12316
Language:
English
Publisher:
Wiley
Publication Date:
2015
detail.hit.zdb_id:
2010864-3
