Desensitization in ABO-Incompatible Kidney Transplantation With Low ABO Iso-Agglutinin Titers

作者：Gelpi R; Cid J; Lozano M; Revuelta I; Sanchez Escuredo A; Blasco M; de Souza E; Esforzado N; Torregrosa J V; Cofan F; Ricart M J; Campistol J M; Oppenheimer F; Diekmann F^*

来源：Transplantation Proceedings, 2015, 47(8): 2340-2343.

DOI：10.1016/j.transproceed.2015.08.021

Background. In ABO-incompatible (ABOi) kidney transplantation (KT) with low iso-agglutinin (IG) titers (IGT), standard pre-conditioning treatment might be excessive. To try to answer this question, we evaluated the pre-conditioning requirements of a group of ABOi KT with low ABO JUT in our center. Our main objective was to assess desensitization requirements for ABOi KT with low JUT (<16) at Hospital Clinic of Barcelona from 2006 to 2014.
Methods. A retrospective study of desensitization (rituximab and plasma exchange [PE]) requirements for ABOi KT with JUT <16 was conducted.
Results. One and 5 years after KT, patient survival was 100%. Renal graft survival was 90% at 1 and 5 years after KT. Mean PE performed before KT was 1.7 (standard deviation [SD], 1.703); 50% of the patients did not receive PE after transplantation, 30% received 2 sessions of PE, and 20% received only 1. The average is 0.8 (SD, 0.91).Follow-up IG determinations remained with low titers (<= 8/8). No rebounds of titers were observed during the first 4 to 6 months after transplantation.
Conclusions. Recipients with JUT <= 8 required none or only 1 PE session to reach acceptable titers (titers <= 4) to perform ABOi KT safely. This information is useful to assess the possibility of a minimized desensitization protocol in ABOi KT donors with low titers of IG to reduce adverse effects, reduce cost, and simplify pre-transplant logistics.

• 出版日期2015-10