AB0 incompatible kidney transplantation using unspecific immunoadsorption.

ABSTRACT

BACKGROUND: A protocol for ABO-incompatible kidney transplantation with antigen specific immunoadsorption, rituximab and conventional immunosuppression has been successfully implemented in many European centers. We report an alternative method for the elimination of isoagglutinins with a number of advantages - large amount of treatable plasma, parallel removal of other rejection-inducing antibodies, long operating life, favorable cost-benefit ratio. METHOD: We report our first successfully treated case of an ABO-incompatible living donor kidney transplantation using Immunoadsorption with Ig-TheraSorb. We performed 5 sessions preoperatively and one after transplantation. Per treatment session twice the calculated plasma volume (4400 ml in this patient) was treated. RESULTS: Per treatment session the IgM- isoagglutinin-titers were reduced from 116 to 11 and the IgG- isoagglutinin-titers from 132 to 12. There were no side effects and the procedure was well tolerated with good renal function 500 days post transplantation. CONCLUSION: Ig-TheraSorb-Immunoadsorption is an alternative method of elimination of harmful antibodies and it enables successful integration of ABO-incompatible transplantation into regular transplantation programs.