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

ABO-incompatible kidney transplantation (ABOi-KT) has become a viable solution to expand access to living donor transplantation, particularly in countries where deceased donor programs are limited. Immunoadsorption (IA) enables selective antibody removal and is widely preferred, but the high cost of single-use IA columns restricts its routine use in low-resource settings. To address this challenge, some Indian centers have adopted structured column reuse under controlled protocols. This study was undertaken to evaluate the clinical safety, immunological efficacy, and practical feasibility of an IA-based desensitization protocol incorporating planned column reuse.

To evaluate the efficacy and safety of immunoadsorption-based desensitization using structured column reuse in ABO-incompatible transplantation.

This was a retrospective study of 13 adult patients who underwent living donor ABO-incompatible kidney transplantation between June 2023 and May 2025. Desensitization involved IA with selective column reuse under validated sterile conditions. All patients received standardized immunosuppression, and isoagglutinin titers were serially monitored. Outcomes included titer reduction, graft function, antibody rebound, rejection episodes, and procedure-related complications. Statistical analysis was performed using standard methods, with p < 0.05 considered significant.

Thirty-five IA sessions were conducted; 60% involved column reuse. Final IgG and IgM titers ≤1:8 were achieved in all patients prior to transplantation. Immediate graft function was seen in 12 patients. Mean serum creatinine at discharge was 1.07 mg/dL. No cases of antibody-mediated rejection, post-transplant isoagglutinin rebound, or reuse-related adverse events were observed. No patients required blood product transfusion or additional apheresis post-transplant. At three months, all patients had functioning grafts, with 100% patient and graft survival. The protocol demonstrated safety, efficacy, and feasibility within a cost-constrained setting.

Immunoadsorption with structured column reuse is an effective, safe, and practical desensitization strategy in ABO-incompatible transplantation, offering a viable approach in resource-limited healthcare systems.