Journal Article

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

Jochen Wilpert, Marcel Geyer, Przemyslaw Pisarski, Oliver Drognitz, Christian Schulz-Huotari, Anette Gropp, Heike Goebel, Peter Gerke, Sven Teschner, Gerd Walz and Johannes Donauer

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 22, issue 10, pages 3048-3051
Published in print October 2007 | ISSN: 0931-0509
Published online July 2007 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfm460
On-demand strategy as an alternative to conventionally scheduled post-transplant immunoadsorptions after ABO-incompatible kidney transplantation

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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.

Keywords: ABO-incompatible; IgG titer; immunoadsorption; indirect antiglobulin test; kidney transplantation

Journal Article.  2459 words.  Illustrated.

Subjects: Nephrology

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