Nephrol Dial Transplant (2002) 17: 1503-1508
© 2002 European Renal Association-European Dialysis and Transplant Association
Peri-operative immunoadsorption in sensitized renal transplant recipients
1 Division of Nephrology and Dialysis, Department of Internal Medicine III, University of Vienna, Austria, 2 Department of Laboratory Medicine, University of Vienna, Austria and 3 Division of Ultrastructural Pathology and Cell Biology, Department of Pathology, University of Vienna, Austria
Background. Re-transplanted kidney allograft recipients with high levels of panel reactive antibodies (PRA) are at increased risk of early immunologic graft loss. In these patients, prophylactic peri-operative antibody depletion by immunoadsorption (IA) could prevent humoral graft injury and thus, in combination with anti-cellular rejection therapy, improve graft survival.
Methods. Twenty re-transplanted and broadly immunized cadaver kidney recipients (median PRA reactivity 87%, range 55–100%) were treated with IA (protein A) immediately before transplantation and during the early post-transplantation period (median number of IA sessions 11, range 1–24). Patients received additional prophylactic anti-lymphocyte antibody therapy. Nineteen patients had a negative pre-transplant cross-match. In one patient, a positive cross-match was rendered negative by the pre-transplant IA session.
Results. One-year graft survival was 80% and patient survival 95%. Median (range) serum creatinine in functioning grafts was 1.6 (0.8–2.7) mg/dl at discharge and 1.5 (1.0–5.8) mg/dl at 1 year. Two grafts were lost due to acute vascular rejection, whereby one rejection occurred after withdrawal of immunosuppression due to septicaemia. One patient had acute cellular rejection, which was reversed by a second course of anti-lymphocyte antibody therapy. Thrombotic microangiopathy and surgical complications were the causes for one graft loss each. Retrospective immunohistochemistry revealed peritubular C4d staining, a presumed marker for humoral alloreactivity, in 12 out of 15 biopsies.
Conclusions. These results suggest that prophylactic peri-operative IA and anti-lymphocyte antibody therapy might be an effective therapeutic strategy for the prevention of early graft failure in sensitized re-transplant recipients.
Keywords: HLA-antibodies; humoral response; hypersensitized patients; immunoadsorption; kidney re-transplant; kidney transplantation; renal graft rejection
Correspondence and offprint requests to: Martin Haas, MD, Division of Nephrology and Dialysis, Department of Internal Medicine III, University of Vienna, Währinger Guertel 18–20, A-1090 Vienna, Austria. Email: martin.haas{at}akh\|[hyphen]\|wien.ac.at
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