Marc Schiesser1, Daniel C Steinemann, Karine Hadaya, Uyen Huynh-Do, Ute Eisenberger, Isabelle Binet, Thomas Fehr, Michael Dickenmann. 1. 1 Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland. 2 Department of Nephrology, University Hospital Bern, Bern, Switzerland. 3 Department of Nephrology, University Hospital Geneva, Geneva, Switzerland. 4 Department of Nephrology, Kantonsspital St. Gallen, St. Gallen, Switzerland. 5 Department of Nephrology, University Hospital Zurich, Zurich, Switzerland. 6 Department of Nephrology, University Hospital Basel, Basel, Switzerland.
Abstract
BACKGROUND: We developed a multicentric Swiss protocol for ABO-incompatible kidney transplantation including immunoadsorption column reuse. The aim of this study was to assess efficacy and safety of immunoadsorption column reuse in ABO-incompatible kidney transplantation. METHODS: We performed a multicentric prospective trial including all ABO-incompatible kidney transplantations in Switzerland from 2005 to 2011. Patients received rituximab and standardized immunosuppression with tacrolimus, mycophenolate mofetil, and steroids. Antigen-specific perioperative immunoadsorption was performed. Immunoadsorption columns were reused after restoration. Graft survival, patient survival, kidney function, rejections, number of columns, adverse events after column reuse, and anti-A/anti-B antibody titers were assessed. RESULTS: Seventy-one ABO-incompatible patients underwent antigen-specific immunoadsorption and could be transplanted across the blood group barrier. Kaplan-Meier estimates for both, patient-censored and death-censored graft survivals were both 97.2% at 5 years. Allograft function was excellent with a mean estimated glomerular filtration rate of 54 mL per min after 1 year. The median number of pretransplant immunoadsorptions was 5. All centers performed column reuse. A total of 394 immunoadsorption procedures were performed with reused filters. Patient survival, graft survival, and adverse events did not differ when filters were reused. Column reuse resulted in cost savings of 21,458 USD per patient. CONCLUSION: We have introduced a national protocol for ABO-incompatible kidney transplantation including immunoadsorption column reuse. Column reuse was efficient and safe.
BACKGROUND: We developed a multicentric Swiss protocol for ABO-incompatible kidney transplantation including immunoadsorption column reuse. The aim of this study was to assess efficacy and safety of immunoadsorption column reuse in ABO-incompatible kidney transplantation. METHODS: We performed a multicentric prospective trial including all ABO-incompatible kidney transplantations in Switzerland from 2005 to 2011. Patients received rituximab and standardized immunosuppression with tacrolimus, mycophenolate mofetil, and steroids. Antigen-specific perioperative immunoadsorption was performed. Immunoadsorption columns were reused after restoration. Graft survival, patient survival, kidney function, rejections, number of columns, adverse events after column reuse, and anti-A/anti-B antibody titers were assessed. RESULTS: Seventy-one ABO-incompatible patients underwent antigen-specific immunoadsorption and could be transplanted across the blood group barrier. Kaplan-Meier estimates for both, patient-censored and death-censored graft survivals were both 97.2% at 5 years. Allograft function was excellent with a mean estimated glomerular filtration rate of 54 mL per min after 1 year. The median number of pretransplant immunoadsorptions was 5. All centers performed column reuse. A total of 394 immunoadsorption procedures were performed with reused filters. Patient survival, graft survival, and adverse events did not differ when filters were reused. Column reuse resulted in cost savings of 21,458 USD per patient. CONCLUSION: We have introduced a national protocol for ABO-incompatible kidney transplantation including immunoadsorption column reuse. Column reuse was efficient and safe.
Authors: Ammon Handisurya; Nina Worel; Werner Rabitsch; Marija Bojic; Sahra Pajenda; Roman Reindl-Schwaighofer; Wolfgang Winnicki; Andreas Vychytil; Hanna A Knaus; Rainer Oberbauer; Kurt Derfler; Philipp Wohlfarth Journal: Front Med (Lausanne) Date: 2020-10-22