Immunoadsorption-Based Desensitization With Column Reuse in ABO-Incompatible Living Donor Renal Transplantation

Area of Science:

• Nephrology and Immunology
• Transplantation Medicine
• Medical Technology

Background:

• ABO-incompatible kidney transplantation (ABOi-KT) is crucial for expanding living donor transplantation, especially where deceased donor options are limited.
• Immunoadsorption (IA) effectively removes antibodies but high costs of single-use columns hinder its use in resource-limited settings.
• Structured column reuse offers a potential cost-saving solution for IA-based desensitization protocols.

Purpose of the Study:

• To evaluate the clinical safety, immunological efficacy, and practical feasibility of an immunoadsorption-based desensitization protocol using planned column reuse.
• To assess the effectiveness of structured column reuse in ABO-incompatible kidney transplantation within a cost-constrained environment.

Main Methods:

• Retrospective analysis of 13 adult patients undergoing living donor ABOi-KT between June 2023 and May 2025.
• Desensitization involved immunoadsorption (IA) with selective column reuse under validated sterile conditions.
• Standardized immunosuppression and serial isoagglutinin titer monitoring were employed; outcomes included titer reduction, graft function, antibody rebound, and complications.

Main Results:

• Thirty-five IA sessions were performed, with 60% utilizing reused columns.
• All patients achieved target IgG and IgM titers (≤1:8) pre-transplant; 12 patients showed immediate graft function with a mean discharge creatinine of 1.07 mg/dL.
• No antibody-mediated rejection, isoagglutinin rebound, or reuse-related adverse events occurred; 100% patient and graft survival at three months.

Conclusions:

• Immunoadsorption with structured column reuse is a safe, effective, and practical desensitization strategy for ABOi-KT.
• This approach offers a viable and cost-effective solution for resource-limited healthcare systems seeking to increase transplantation access.