The First North American Experience Using Glycosorb Immunoadsorption Columns for Blood Group-Incompatible Kidney Transplantation.
Can J Kidney Health Dis 2020;
7:2054358120962586. [PMID:
33101699 PMCID:
PMC7549322 DOI:
10.1177/2054358120962586]
[Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/12/2020] [Indexed: 01/23/2023] Open
Abstract
Background:
Blood group incompatibility (ABOi) is the most common barrier to living donor
kidney transplantation. Options for such recipients include kidney paired
donation (KPD) or desensitization methodology to reduce blood antibody
response.
Objective:
The objective of this study is to report on the first North America
experience in ABOi living donor kidney transplantation using Glycosorb ABO
immunoadsorption columns.
Design:
Retrospective observational cohort study.
Setting:
Renal transplant program at St. Michael’s Hospital, Unity Health Toronto,
University of Toronto.
Patients:
Twenty-six ABOi living donor transplants from August 2011 through February
2020 were undertaken at our center.
Measurements:
Renal allograft and patient survival postdesensitization for ABOi living
donor transplants and isohemagglutinin titer reduction.
Methods:
Preoperative immunosuppressive regimen consisted of a single dose of
Rituximab 375 mg/m2 IV on day −28; tacrolimus, mycophenolic acid,
and prednisone to start on day −7. Immunoadsorption treatments with
Glycosorb A or B columns were performed on day −7 through day −1 based on
anti-A or anti-B titers on Spectra Optia Apheresis System. Immunosuppression
included basiliximab, solumedrol followed by oral prednisone, once-daily
tacrolimus, and mycophenolic acid. The mean follow-up was 53 months (3-96
months).
Results:
A total of 26 individuals underwent an attempt at desensitization of whom 24
patients underwent immediate transplant. One patient had a rebound in titers
and subsequently was transplanted from a blood group compatible living
donor. A second patient had an unrelated medical issue and desensitization
was discontinued. Five-year patient survival was 96% and death censored
allograft survival was 92%. Posttransplant anti-A or anti-B titers were
monitored daily for the first 7 days posttransplant and every 2 days from
days 7 to 14. There were no acute rejections seen in this cohort of
transplant recipients.
Limitations:
As our protocol was first initiated as proof of concept, a few recipients had
low initial isohemagglutinin titers. This may have contributed to improved
clinical outcomes.
Conclusions:
ABO column immunoadsorption with specific columns is a safe and effective
method for ABOi living donor kidney transplantation, and an option when KPD
is less than ideal.
Trial not registered as this was a retrospective cohort review.
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