Medizinische Universität Graz - Research portal
Selected Publication:
SHR Neuro Cancer Cardio Lipid Metab Microb
Becker, LE; Siebert, D; Süsal, C; Opelz, G; Leo, A; Waldherr, R; Macher-Goeppinger, S; Schemmer, P; Schaefer, SM; Klein, K; Beimler, J; Zeier, M; Schwenger, V; Morath, C.
Outcomes Following ABO-Incompatible Kidney Transplantation Performed After Desensitization by Nonantigen-Specific Immunoadsorption.
Transplantation. 2015; 99(11):2364-2371
Doi: 10.1097/TP.0000000000000753
Web of Science
PubMed
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- Co-authors Med Uni Graz
- Schemmer Peter
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- Abstract:
- For desensitization of ABO-incompatible kidney transplant recipients we recently proposed nonantigen-specific immunoadsorption (IA) and rituximab. We now compared clinical outcomes of 34 ABO-incompatible living-donor kidney recipients who were transplanted using this protocol with that of 68 matched ABO-compatible patients. In addition, we analyzed efficacy and cost of nonantigen-specific as compared to blood group antigen-specific IA. Before desensitization, the median isoagglutinin titer of 34 ABO-incompatible patients was 1:64 (Coombs technique). Patients received a median of 7 preoperative IA treatments. Twenty-four patients had a median of 2 additional plasmapheresis treatments to reach the preoperative target isoagglutinin titer of 1:8 or less. After a median postoperative follow-up of 22 months, overall graft survival in the ABO-incompatible group was not significantly different from that in ABO-compatible patients (log-rank P = 0.20), whereas patient survival tended to be lower (log-rank P = 0.05). The incidence of rejection episodes was 15% in both groups. The ABO-incompatible kidney recipients had a higher incidence of BK virus replication (P = 0.04) and nephropathy (P = 0.01) and showed more often colonization with multidrug resistant bacteria (P = 0.02). In comparison to blood group antigen-specific IA, nonantigen-specific IA showed equal efficacy but was associated with reduction in cost. Clinical outcomes of ABO-incompatible patients desensitized with a nonantigen-specific IA device and rituximab do not differ from that of matched ABO-compatible patients although a trend toward reduced patient survival was noted. Special attention must be paid to the higher incidence of BK virus infection in recipients of ABO-incompatible grafts.
- Find related publications in this database (using NLM MeSH Indexing)
- ABO Blood-Group System - immunology
- Adolescent -
- Adult -
- Aged -
- BK Virus - immunology
- BK Virus - pathogenicity
- Blood Group Incompatibility - blood
- Blood Group Incompatibility - diagnosis
- Blood Group Incompatibility - immunology
- Cost-Benefit Analysis -
- Desensitization, Immunologic - adverse effects
- Desensitization, Immunologic - economics
- Desensitization, Immunologic - methods
- Desensitization, Immunologic - mortality
- Female -
- Graft Rejection - immunology
- Graft Rejection - prevention & control
- Graft Survival -
- Health Care Costs -
- Histocompatibility -
- Histocompatibility Testing -
- Humans -
- Immunocompromised Host -
- Immunosuppressive Agents - therapeutic use
- Kaplan-Meier Estimate -
- Kidney Transplantation - adverse effects
- Kidney Transplantation - economics
- Kidney Transplantation - mortality
- Male -
- Middle Aged -
- Plasmapheresis - adverse effects
- Plasmapheresis - economics
- Plasmapheresis - mortality
- Polyomavirus Infections - immunology
- Polyomavirus Infections - virology
- Risk Factors -
- Rituximab - therapeutic use
- Time Factors -
- Treatment Outcome -
- Tumor Virus Infections - immunology
- Tumor Virus Infections - virology
- Young Adult -