Date: Monday, May 4, 2015
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Background: After ABO-incompatible kidney transplantation, postoperative plasma exchange (PE) or immunoadsorption (IA) is performed per protocol or depending on postoperative A/B-titers to prevent acute rejection. However, the need for postoperative PE or IA is not known.
Methods: Since 2006, 30 consecutive patients received three postoperative IAs as per protocol. Starting from 2009, the last 46 patients received only preoperative IA. Preoperative desensitization consisted of rituximab, tacrolimus, mycophenolate mofetil, prednisone and intravenous immunoglobulins. Antigen-specific IA was performed pre-operatively with the Glycosorb device. Initial IgG titers of ≤1:256 were accepted for desensitisation and the target for the IgG titer was <1:8 after the last IA.
Biopsy-proven acute rejections either antibody-mediated (AMR) or mixed cellular and antibody-mediated (MAR) within three months were recorded.
Results: The postoperative titer in patients with postoperative IA did not exceed 1:16 (IgG 1:4 [<2-16], median and range). The postoperative IgG titer was not significantly different after abandoning postoperative IA, although three patients had titers of 1:32 and one patient even 1:128 (IgG 1:8 [<2-128], p=0.6). Rejections were more frequent in the group with postoperative IA: 6 AMR and 3 MAR were recorded in 30 patients, versus 4 AMR in the 46 patients without postoperative IA (30 vs. 9%, p=0.03). Baseline characteristics differed however: in the group with postoperative IA the vast majority had blood group O (87 vs. 52%, p=0.003). Also the IgG titer on the day of transplantation was slightly higher (1:4 [<2-16] vs. 1:2 [<2-32], p=0.007). All 13 patients with AMR and MAR rejections had postoperative IgG titers ≤1:16. Renal function at one year follow-up was comparable between patients with and without postoperative IA (mean 145.5 umol/L vs. 140.0 umol/L respectively, p=0.7).
Conclusion: Postoperative removal of A/B-antibodies can be safely removed from the ABO-incompatible transplantation protocol using strict preoperative criteria for antibody lowering.
To cite this abstract in AMA style:Weerd Ade, Agteren Mvan, Ijzermans J, Weimar W, Betjes M. Post-Transplantation Immunoadsorption Can Be Safely Withheld After ABO-Incompatible Kidney Transplantation [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/post-transplantation-immunoadsorption-can-be-safely-withheld-after-abo-incompatible-kidney-transplantation/. Accessed November 17, 2019.
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