ABO-incompatible kidney transplantation using antigen-specific immunoadsorption and rituximab: a single center...

Area of Science:

• Nephrology
• Transplantation Immunology
• Immunoadsorption Therapy

Background:

• Traditional ABO-incompatible kidney transplantation involved intensive plasmapheresis, immunosuppression, and splenectomy, leading to high early post-transplant morbidity.
• A novel protocol utilizing rituximab and antigen-specific immunoadsorption has emerged as a promising alternative, demonstrating excellent short-term outcomes.

Purpose of the Study:

• To evaluate the efficacy and safety of a new protocol for ABO-incompatible kidney transplantation.
• To assess the effectiveness of rituximab combined with antigen-specific immunoadsorption in reducing antibody titers and preventing humoral rejection.

Main Methods:

• Eleven patients received rituximab (375 mg/m2) 3-4 weeks pre-transplant, followed by standard triple immunosuppression (tacrolimus, mycophenolate mofetil, prednisone).
• Antigen-specific immunoadsorption was employed to reduce IgG and IgM anti-A or anti-B antibody titers to below 1:8 pre-transplant, with additional treatments post-surgery if titers increased.
• Intravenous immunoglobulins were administered the day before transplantation.

Main Results:

• Eight of 11 patients (mean age 52 years) underwent successful transplantation, with a mean follow-up of 7 months.
• No humoral rejections were observed in the transplanted patients; all grafts showed primary function.
• Three patients could not be transplanted due to rapid increases in isoagglutinin titers despite immunoadsorption; one patient died from sepsis post-transplant.

Conclusions:

• Antigen-specific immunoadsorption combined with conventional triple immunosuppression offers excellent short-term results for ABO-incompatible kidney transplantation.
• This protocol is highly effective in managing high isoagglutinin titers, making transplantation a viable option for end-stage renal disease patients without a blood group-compatible donor.