The First Fifty ABO Blood Group Incompatible Kidney Transplantations: The Rotterdam Experience.

This study describes the single center experience and long-term results of ABOi kidney transplantation using a pretransplantation protocol involving immunoadsorption combined with rituximab, intravenous immunoglobulins, and triple immune suppression. Fifty patients received an ABOi kidney transplant in the period from 2006 to 2012 with a follow-up of at least one year. Eleven antibody mediated rejections were noted of which 5 were mixed antibody and cellular mediated rejections. Nine cellular mediated rejections were recorded. Two grafts were lost due to rejection in the first year. One-year graft survival of the ABOi grafts was comparable to 100 matched ABO compatible renal grafts, 96% versus 99%. At 5-year follow-up, the graft survival was 90% in the ABOi versus 97% in the control group. Posttransplantation immunoadsorption was not an essential part of the protocol and no association was found between antibody titers and subsequent graft rejection. Steroids could be withdrawn safely 3 months after transplantation. Adverse events specifically related to the ABOi protocol were not observed. The currently used ABOi protocol shows good short and midterm results despite a high rate of antibody mediated rejections in the first years after the start of the program.

Regional citrate versus heparin anticoagulation during venovenous hemofiltration in patients at low risk for bleeding: similar hemofilter survival but significantly less bleeding.

BACKGROUND: Regional citrate anticoagulation (RCA) may be a valuable alternative to systemic heparin anticoagulation during continuous venovenous hemodialysis (CVVH). RCA does not increase the risk of bleeding, but carries the risk of metabolic derangements. Clotting-free circuit survival may be increased with RCA. METHODS: Critically ill patients at low risk for bleeding were randomized for CVVH with RCA or systemic heparin anticoagulation. A maximum of 4 consecutive CVVH circuits were analyzed for every patient. Clotting-free circuit survival, adverse metabolic events and bleeding complications were recorded. RESULTS: Forty-eight patients were included in the study and randomized for RCA (n=21) or systemic heparin (n=27). A total of 142 CVVH circuits were analyzed with a median of 3 circuits per patient. Uncensored circuit survival and median clotting-free circuit survival were similar for both groups. No significant adverse metabolic events occurred in the RCA group. Major bleedings were not recorded in the RCA group, compared with 10 events in the heparin group (p<0.01). The number of red blood cell units given per day of CVVH was significantly higher in the heparin group (0.88 vs 0.43 units/day, p=0.01). Also, the mean decrease in hemoglobin concentration per day in the nontransfused stable patients, was significantly higher in the heparin group. CONCLUSION: RCA during CVVH can be performed safely, with a circuit survival similar to systemic heparin anticoagulation, but significantly lower incidence of bleeding. Citrate anticoagulation should be advocated as first choice, also for critically ill patients considered to be at low risk for bleeding.