Antigen-Specific versus Non-Antigen-Specific Immunoadsorption in ABO-Incompatible Renal Transplantation

Area of Science:

• Nephrology
• Immunology
• Transplantation

Background:

• ABO-incompatible renal transplantation (RTx) expands donor options for end-stage renal disease patients.
• Immunoadsorption (IA) is crucial for removing pre-formed antibodies before RTx.
• This study compares antigen-specific and non-antigen-specific IA in ABOi RTx.

Purpose of the Study:

• To compare the efficacy of antigen-specific (Glycosorb) versus non-antigen-specific (Immunosorba) IA in ABOi RTx.
• To evaluate antibody reduction, treatment parameters, complications, costs, and patient outcomes.
• To assess the impact of IA type on allograft function and survival.

Main Methods:

• 10 patients received antigen-specific IA (Glycosorb).
• 13 patients underwent non-antigen-specific IA (Immunosorba).
• Comparison of IgG/IgM reduction, IA treatments, complications, costs, and 1-year allograft function and survival.

Main Results:

• Both IA methods equally reduced IgG levels.
• Antigen-specific IA (Glycosorb) was more effective in reducing IgM levels (p=0.0172).
• One-year allograft function (eGFR 66 vs. 64 ml/min/1.73m²) and death-censored graft survival (90.0% vs. 92.3%) were similar. Non-antigen-specific IA was more cost-effective but less time-efficient.

Conclusions:

• Antigen-specific IA offers superior IgM reduction in ABOi RTx.
• Both IA approaches yield comparable long-term patient and graft outcomes.
• Future IA techniques may enhance efficiency and cost-effectiveness.