5-Year Follow-Up of Patients Successfully Transplanted after Immunoadsorption to Remove Anti-HLA Antibodies

Abstract

The function of renal allografts in patients who had received pretransplant immunoadsorption in order to remove cytotoxic anti-HLA antibodies was studied. We reviewed 6 patients who received a graft which functioned beyond 3 months; the mean follow-up period was 76 (range 62-89) months. Two grafts have been lost from chronic rejection, at 12 and 62 months, respectively. The mean plasma creatinine levels at 1 and 5 years were 169 (range 143-211) μmol/l and 155 (range 92-235) μmol/l, respectively (1.91, range 1.62-2.39, mg/dl and 1.75, range 1.04-2.66, mg/dl, respectively). The major source of morbidity during long-term follow-up has been the occurrence of renal artery stenosis in 5 patients and renal vein stenosis in 1. In conclusion, the 5-year graft survival and function was good in patients who received immunoadsorption and whose grafts survived beyond the first 3 months after transplantation.

Successful Renal Transplantation across Simultaneous ABO Incompatible and Positive Crossmatch Barriers

“…The history of attempts at pre-emptive antibody removal as a means to breach immunologic and blood group barriers is characterized by the parallel development of two broad approaches. The first, plasmapheresis or immunoadsorption has been used to remove anti-HLA antibody and isoagglutinins but antibody frequently re-emerges after cessation of treatment (13)(14)(15). Alternatively, high-dose intravenous immunoglobulin (IVIG) can reduce HLA sensitization and abrogate a positive crossmatch through the putative activation of immunomodulatory pathways and anti-idiotypic networks.…”

C4d and C3d Staining in Biopsies of ABO- and HLA-Incompatible Renal Allografts: Correlation with Histologic Findings

“…Over the past 10–15 years, an increasing number of transplant centers worldwide have successfully expanded the potential pool of living kidney donors by performing transplants of crossmatch positive or ABO‐incompatible kidneys into recipients who are preconditioned to remove antibodies specific for donor HLA or ABO antigens (1–8). A potential risk of such procedures, however, is the continued presence or reappearance of such antibodies with resulting antibody‐mediated rejection (AMR) of the graft.…”

Subclinical Acute Antibody-Mediated Rejection in Positive Crossmatch Renal Allografts

“…Over the past 10–15 years, an increasing number of transplant centers worldwide have successfully expanded the potential pool of living kidney donors by performing transplants of crossmatch positive (HLA‐incompatible) kidneys into recipients who are preconditioned to remove donor‐specific antibodies (DSA) (1–7). A potential risk of such procedures, however, is the continued presence or reappearance of such antibodies with resulting antibody‐mediated rejection (AMR) of the graft.…”