Excellent Long-Term Outcome of ABO-Incompatible Living Kidney Transplantation by Reduced-Session of Plasmapheresis of Desensitization Protocol
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 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.
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 March 26, 2023.
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