Antigen-Specific versus Non-Antigen-Specific Immunoadsorption in ABO-Incompatible Renal Transplantation

Abstract

IntroductionABO-incompatible (ABOi) renal transplantation (RTx) from living donors is an established procedure to expand the donor pool for patients with end stage renal disease. Immunoadsorption (IA) is a standard procedure for the removal of preformed antibodies against the allograft. In this study, antigen-specific and non-antigen-specific IA in ABOi RTx were compared.Patients and Methods10 patients underwent antigen-specific IA (Glycosorb group) and 13 patients non-antigen-specific IA (Immunosorba group). The effects of both procedures regarding antibody reduction, number of treatments, complications, costs, as well as the allograft function and patient survival were compared between both groups.ResultsAlthough the IgG levels were reduced equally by both procedures (p=0.82), the reduction of the IgM level was more effective in the Glycosorb group (p=0.0172). Patients in both groups required a median number of 6 IA before ABOi RTx. Allograft function at one year after AB0i RTx was similar in both groups (estimated glomerular filtration rate: 66 vs. 64 ml/min/1.73m² respectively), with a death-censored graft survival of 90.0% and 92.3% respectively. Complication rates did not differ between procedures. Due to the reuse of non-antigen-specific Immunosorba columns, costs were considerably lower in this group; however, the use of the Immunosorba-based IA was less time-efficient.ConclusionConsidering upcoming alternatives as simultaneous performance of dialysis and IA or a possible reuse of Glycosorb columns, this might become less relevant in the future.

Immunoadsorption Techniques and Its Current Role in the Intensive Care Unit

“…In 2001, Tydén et al published a protocol utilising immunoadsorption and rituximab as an adjunct to standard triple therapy immunosuppression to significantly reduce the blood group antigens prior to transplantation. This regimen has now been used extensively, particularly in Europe, with excellent long-term outcomes, comparable to ABO compatible transplantation [33][34][35][36][37][38].…”

Successful Transplantation in ABO‐ and HLA‐Incompatible Living Kidney Transplant Patients: A Report on 12 Cases

“…In the setting of ABO-incompatible kidney transplantation it has been shown recently that non-antigen specific columns (Immunosorba) were as efficient as antigen-specific columns (Glycosorb) in terms of the median number of sessions per patient before transplantation, allograft function at one year, and death-censored graft survival at 1-year (28). Complication rates did not differ between procedures.…”

“…Complication rates did not differ between procedures. Although the reuse of non-antigen-specific Immunosorba columns means that costs are considerably lower in this group, the use of Immunosorbabased immunoadsorption is less time-efficient than that with Glycosorb columns (28). These results are in accordance with those reported very recently by Becker et al, which demonstrated that the clinical outcomes of ABO-incompatible kidney transplant patients that were desensitized at pretransplant with a non-antigen-specific immunoadsorption device plus rituximab do not differ from matched ABOcompatible kidney-transplant patients, although the authors did find a higher rate of BKV infections in ABOi patients (29).…”

Successful adsorption of anti‐A/B antibodies with multiple personal use columns in AB0 incompatible kidney recipients: A single centre experience

“…These columns are coated with either blood group A or B antigens and allow selective removal only of anti-A/B antibodies without depletion of total immunoglobulin, no replacement required. Due to the depletion of coagulation factors, PPs is thought to cause more bleeding complications when compared to IA [9,10]. The disadvantages of IA are two: a high cost if column is not reused and no removal of anti-HLA antibodies [5].…”