Isoagglutinin adsorption in ABO-incompatible transplantation

Area of Science:

• Nephrology
• Immunology
• Transplantation

Background:

• Growing demand for kidney transplants necessitates expanding the donor pool.
• ABO-incompatibility is a major barrier to living donor kidney donation.
• Previous desensitization protocols involved high-risk procedures like plasmapheresis and splenectomy.

Purpose of the Study:

• To develop and evaluate a safer, more effective protocol for ABO-incompatible kidney transplantation.
• To assess the efficacy of antigen-specific immunoadsorption and rituximab in eliminating anti-A/B antibodies.
• To reduce surgical and infectious complications associated with traditional desensitization methods.

Main Methods:

• Developed a protocol using antigen-specific immunoadsorption and rituximab.
• Combined this with standard maintenance immunosuppression (tacrolimus, mycophenolate mofetil, corticosteroids).
• Performed 50 ABO-incompatible kidney transplantations since 2001.

Main Results:

• Antigen-specific immunoadsorption was well-tolerated with no serious side effects.
• Patient and graft survival rates were comparable to ABO-compatible living donor kidney transplants.
• Achieved 0% incidence of antibody-mediated rejection and maintained excellent kidney function.

Conclusions:

• ABO-incompatible kidney transplantation using antigen-specific immunoadsorption and rituximab is safe and effective.
• This protocol eliminates the need for plasmapheresis and splenectomy, reducing associated risks.
• ABO-incompatible kidney transplantation is now a viable option, equivalent to ABO-compatible transplantation.