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NDT Advance Access published online on July 10, 2007
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfm460
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

On-demand strategy as an alternative to conventionally scheduled post-transplant immunoadsorptions after ABO-incompatible kidney transplantation

Jochen Wilpert1,*, Marcel Geyer1,*, Przemyslaw Pisarski2, Oliver Drognitz2, Christian Schulz-Huotari3, Anette Gropp3, Heike Goebel4, Peter Gerke1, Sven Teschner1, Gerd Walz1 and Johannes Donauer1

1University Hospital Freiburg, Renal Division, Germany, 2University Hospital Freiburg, Surgery Division, Transplant Unit, Germany, 3University Hospital Freiburg, Department of Transfusion Medicine, Germany and 4University Hospital Freiburg, Department of Pathology, Germany

Correspondence and offprint requests to: J. Wilpert, Renal Division, Hugstetter Strasse 55, 79106 Freiburg, Germany. Email: jochen.wilpert{at}uniklinik-freiburg.de



  Abstract

Background. Since 2001, approximately 100 ABO-incompatible kidney transplantations have been performed in Europe. The standard protocol, employed by most transplant centres, uses rituximab and scheduled pre-emptive antigen-specific immunoadsorption on post-operative days 3, 6 and 9.

Methods. Our centre has performed 22 ABO-incompatible kidney transplantations since 2004, using a different approach; like in Sweden, all patients received immunoadsorptions preoperatively, but instead of scheduling pre-emptive post-transplant immunoadsorptions, we submitted patients to immunoadsorptions post-operatively only, if their isoagglutinine titers (IgG-Anti-A or -B) exceeded certain thresholds. These thresholds were greater than 1 : 8 in the first post-operative week and greater than 1 : 16 in the second post-operative week, respectively.

Results. A shorter pre-operative length on dialysis, a blood-type constellation of donor A1/recipient 0 and 9a high initial starting-titer were identified as predictors for post-operative immunoadsorptions.

Conclusion. Using this on-demand strategy, our data reveal that a titer-dependent protocol reduces costs at no additional risk for the patient.

Keywords: ABO-incompatible; IgG titer; immunoadsorption; indirect antiglobulin test; kidney transplantation

*These authors contributed equally to the work.

Received for publication: 13. 3.07
Accepted in revised form: 13. 6.07


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 Nephrol Dial TransplantHome page
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