Therapeutic apheresis in ABO-incompatible kidney and liver transplantation: A single-center experience of 50 patients.
ABO Blood-Group System
/ immunology
Adult
Aged
Blood Group Incompatibility
/ immunology
Female
Graft Rejection
/ immunology
Graft Survival
Humans
Immunosorbent Techniques
Immunosuppressive Agents
/ therapeutic use
India
Kidney Transplantation
Liver Transplantation
Male
Middle Aged
Plasmapheresis
/ methods
Retrospective Studies
Transplantation Conditioning
ABO incompatible
desensitization
kidney transplant
liver transplant
preconditioning
rituximab
therapeutic apheresis
titer
Journal
Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy
ISSN: 1744-9987
Titre abrégé: Ther Apher Dial
Pays: Australia
ID NLM: 101181252
Informations de publication
Date de publication:
Feb 2021
Feb 2021
Historique:
received:
15
11
2019
revised:
07
02
2020
accepted:
31
03
2020
pubmed:
9
4
2020
medline:
8
10
2021
entrez:
9
4
2020
Statut:
ppublish
Résumé
ABO antigens play an important role in solid organ transplantation. Desensitization for ABO incompatibility offers patients awaiting transplant a larger donor pool. The aim of this study was to assess outcome of desensitization using the institutional preconditioning protocol in ABO-incompatible solid organ transplants. A retrospective analysis of ABO-incompatible solid organ transplants between October 2015 and June 2018, at a tertiary healthcare center was performed. The preconditioning regimen consisted of immunosuppression and therapeutic apheresis (TA). Pre- and post-TA titers were performed, until a target titer of 8 or below was achieved, at which transplant was performed. Follow-up data till 1 year was analyzed. A total of 50 ABO-incompatible solid organ transplantations, including 14 liver transplants and 36 renal transplants were analyzed. The median baseline anti-A and anti-B titers were 192 and 256, respectively. A total of 150 therapeutic plasma exchange (TPE) procedures were performed for renal transplant recipients; 19 TPE and eight immunoadsorption procedures (five preoperative and three intraoperative) were performed for liver transplant recipients. Five (10%) patients experienced minor adverse events. Biopsy revealed antibody-mediated rejection was observed in three cases in the immediate posttransplant phase and in three (6.67%) cases over 1 year. There was one death due to transplant-associated thrombotic microangiopathy. Graft survival for renal transplant was 100% and death-censored graft survival for liver transplant was 100%. Despite difficulties, ABO-incompatible transplants can be performed without antibody-mediated rejection with the use of an appropriate protocol.
Identifiants
pubmed: 32266793
doi: 10.1111/1744-9987.13495
doi:
Substances chimiques
ABO Blood-Group System
0
Immunosuppressive Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
103-117Informations de copyright
© 2020 International Society for Apheresis, Japanese Society for Apheresis, and Japanese Society for Dialysis Therapy.
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