*Purpose: : Immunoadsorption (IA) is an apheresis procedure that has been shown to be effective in the ABO incompatible living donor kidney transplantation (ABOi LDKT) conditioning, as well as in acute antibody-mediated rejection (AMR) treatment.However, in the case of the ABOi LDKT, a cut-off point of the isoagutinins baseline titre which suggest using plasma exchange (PE) over IA has not been defined. On the other hand, there is also no homogeneity in therapeutic protocols based on IA for the treatment of acute AMR. In chronic active AMR, there are no data that assess its usefulness.

*Methods: ABOi LDKT recipients and those with an AMR between January 2012 and May 2018 were included. They both were submitted to a desensitization and treatment protocol (respectively) based on nonantigen-specific IA, rituximab, intravenous gammaglobulin, individualized immunosuppression and rescue PE if necessary. The primary endpoint was graft and patient survival. Moreover, usefulness of isoagglutinin basal titre as an element to indicate IA or PE (in the LDKT ABOi) and the immunological and histological changes after the treatment (in the AMR) were evaluated.

*Results: 9 potential recipients of an ABOi LDKT were included. 8 reached the target titre of pretransplant isoagglutinins. After a mean follow-up of 58±19 months, graft and patient survival were 100% and 83%, respectively. Basal titres close to 1/64 predicted a high probability of requiring rescue PE. In the case of AMR, 14 patients were included (9 acute, 5 chronic active) with a 100% patient survival and 83% and 60% graft survival, respectively (mean follow-up 19±19 months). There was no evidence of significant decrease in immunological parameters. In contrast, histological rejection signs in the responding patients improved.

*Conclusions: Nonantigen-specific IA is an effective technique for ABOi LDKT conditioning, Moreover, for the first time, we have propose a basal isoagglutinin titre (<1/64) as a key point to evaluate the future success or requirements of extra PE. In addition, IA is also effective for acute AMR.

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