ABO-incompatible kidney transplantation using regenerative selective immunoglobulin adsorption

Background: ABO‐incompatible (ABOi) kidney transplantation is an established procedure relying on the removal of donor‐specific isoagglutinine antibodies as part of the recipient preconditioning. At present, current protocols using immunoadsorption apply a single‐use selective carbohydrate isoagglutinine adsorber. A regenerative and selective immunoglobulin immunoadsorption could be an alternative but has not been reported for ABOi transplantation. Methods: Eight patients were treated with the commonly used isoagglutinine carbohydrate epitope adsorber and seven with a regenerative polyclonal sheep anti‐immunoglobulin adsorber as part of the preconditioning for ABOi kidney transplantation. An IgG‐isoagglutinine titer of less or equal 1:4 qualified for transplantation. Treatment safety, efficiency, length of desensitization, number of postoperative immunoadsorptions, and allograft outcome were retrospectively compared. Results: With the use of the immunoglobulin adsorber the median initial isoagglutinine IgG titers of 1:64 (range 1:32–1:256) were lowered to the target of 1:4 preoperatively with a mean of 6.2 immunoadsorptions (range 5–11). Mean IgG/IgM titer step reduction per IA was 1.98/1.21 for (range 0–4/0–4) and mean titer step rebound 1.31/0.82 (range 0–4/0–3), respectively. The number of immunoadsorptions and length of desensitization was not different from the use of the specific isoagglutinine adsorbers. After transplantation, no rejection occurred and only one postoperative immunoadsorption was necessary. No adverse events in relation to immunoadsorption were observed. Graft function was comparable to the isoagglutinine adsorber group. Conclusion: These data suggest that ABOi kidney transplantation can be performed safely and effectively with a selective regenerative immunoglobulin immunoadsorber. J. Clin. Apheresis, 2012. © 2012 Wiley Periodicals, Inc.