Outcomes following ABO-incompatible kidney transplantation performed after desensitization by nonantigen-specific immunoadsorption

• Verfasst von: Becker, Luis Eduardo [VerfasserIn]
• Verfasst von: Siebert, Daniela [VerfasserIn]
• Verfasst von: Süsal, Caner [VerfasserIn]
• Verfasst von: Opelz, Gerhard [VerfasserIn]
• Verfasst von: Leo, Albrecht [VerfasserIn]
• Verfasst von: Waldherr, Rüdiger [VerfasserIn]
• Verfasst von: Macher-Göppinger, Stephan [VerfasserIn]
• Verfasst von: Schemmer, Peter [VerfasserIn]
• Verfasst von: Schäfer, Sebastian Markus [VerfasserIn]
• Verfasst von: Klein, Katrin [VerfasserIn]
• Verfasst von: Beimler, Jörg [VerfasserIn]
• Verfasst von: Zeier, Martin [VerfasserIn]
• Verfasst von: Schwenger, Vedat [VerfasserIn]
• Verfasst von: Morath, Christian [VerfasserIn]
• Titel: Outcomes following ABO-incompatible kidney transplantation performed after desensitization by nonantigen-specific immunoadsorption
• Verf.angabe: Luis E. Becker, Daniela Siebert, Caner Süsal, Gerhard Opelz, Albrecht Leo, Rüdiger Waldherr, Stephan Macher-Goeppinger, Peter Schemmer, Sebastian Markus Schaefer, Katrin Klein, Jörg Beimler, Martin Zeier, Vedat Schwenger, and Christian Morath
• E-Jahr: 2015
• Jahr: 11 January 2015
• Umfang: 8 S.
• Fussnoten: Gesehen am 04.08.2020
• Titel Quelle: Enthalten in: Transplantation
• Ort Quelle: Hagerstown, Md. : Lippincott Williams & Wilkins, 1963
• Jahr Quelle: 2015
• Band/Heft Quelle: 99(2015), 11, Seite 2364-2371
• ISSN Quelle: 1534-6080
• DOI: doi:10.1097/TP.0000000000000753
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1726120562

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.