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Excellent Long-Term Outcome of ABO-Incompatible Living Kidney Transplantation by Reduced-Session of Plasmapheresis of Desensitization Protocol

Y. Ishiyama1, K. Tanabe2, T. Kanzawa2, K. Unagami2, H. Ishida2, T. Takagi2

1Urology, Tokyo Women's Medical University Medical Center East, Arakawa, Japan, 2Tokyo Women's Medical University, Tokyo, Japan

Meeting: 2022 American Transplant Congress

Abstract number: 1026

Keywords: Kidney transplantation, Plasmapheresis

Topic: Clinical Science » Kidney » 36 - Kidney Immunosuppression: Desensitization

Session Information

Session Name: Kidney Immunosuppression: Desensitization

Session Type: Poster Abstract

Date: Sunday, June 5, 2022

Session Time: 7:00pm-8:00pm

 Presentation Time: 7:00pm-8:00pm

Location: Hynes Halls C & D

*Purpose: Plasmapheresis (PE) is applied to ABO-incompatible living kidney transplantation (ABOi-LKT) in order to remove ABO blood type antibody to obtain the appropriate target levels. Recently, number of PE sessions was reduced significantly because of PE-related adverse events and cost. We examined whether reduced session of PE could affect outcome of ABOi-LKT.

*Methods: We retrospectively analyzed 417 patients who underwent ABOi-LKT at Tokyo Women’s Medical University Hospital between 2001 and 2020. In addition to immunosuppressive regimen consisted of methylprednisolone, tacrolimus, mycophenolate mofetil and either rituximab/splenectomy, double-filtration plasmapheresis (DFPP) were routinely utilized as a mode of PE. During the first decade (2001-2010) 3 to 4 cycles of DFPP were administered prior to transplant, while the number was reduced to 1-2 cycles for the latter decade (2011-2020). First, the study cohort was divided into two groups, i.e., Conventional PE (2001-2010, N=138) and Reduced PE (2011-2020, N=279) and the incidence of antibody mediated rejection, death-censored graft survival (DCGS) and overall survival were compared. Additionally, impact of number of DFPP cycles on DCGS was analyzed using multivariable Cox-hazard model.

*Results: Number of DFPP cycles performed was 3.6 [±1.3] in the Conventional PE group and 1.8 [±1.1] in the Reduced PE group, respectively (p<0.001). Patients in the Conventional PE group was younger than the Reduced PE group (44.8±13.8 vs 52.0±11.9 years, p<0.001) and less frequently received preemptive kidney transplantation (KT) (4.3% vs. 24.4%, p<0.001).There were no difference in incidence of antibody mediated rejection during the 10 years follow-up (21.0% vs. 18.3%, p=0.505) as well as 10-year DCGS (88.3% vs. 91.4%, p=0.878) and OS (97.1% vs 91.6%, p=0.055). In the multivariable analysis, number of DFPP were not shown to be an independent predictor of DCGS (adjusted HR=0.98 [0.71-1.34], p=0.882) when analyzed with factors such as preoperative maximum anti-ABO antibodies (IgG, IgM) , preformed DSA or preemptive KT.

*Conclusions: In our experience, reducing the number of pretransplant DFPP before ABOi-LKT did not result in significant inferior post-transplant outcomes or survivals.

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To cite this abstract in AMA style:

Ishiyama Y, Tanabe K, Kanzawa T, Unagami K, Ishida H, Takagi T. Excellent Long-Term Outcome of ABO-Incompatible Living Kidney Transplantation by Reduced-Session of Plasmapheresis of Desensitization Protocol [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/excellent-long-term-outcome-of-abo-incompatible-living-kidney-transplantation-by-reduced-session-of-plasmapheresis-of-desensitization-protocol/. Accessed May 9, 2025.

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