Immunoadsorption in Sensitized Kidney Transplant Recipients

Ron Shapiro, MD


November 08, 2010

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Hi, my name is Ron Shapiro. I'm a transplant surgeon at the University of Pittsburgh. Today I want to talk to you about a very interesting paper[1] dealing with the problem of sensitization in patients waiting for a kidney transplant.

The group in Vienna reported on immediate pretransplant immunoadsorption with protein A in an attempt to render the crossmatch negative and go forward with transplantation. They have 5 years' follow-up on a population of patients whose crossmatch became negative after immunoadsorption. They were compared with patients who were crossmatch negative but were sensitized pretransplantation, and those who were crossmatch negative but had positive DSA [donor-specific antibodies]. They found comparable 5-year patient and graft survival and a comparable incidence of both antibody-mediated and acute cellular rejection, as well as renal function.

Pursuing this approach, which can avoid a long attempt at desensitization with IVIG [intravenous immunoglobulin] and rituximab, for example, or with other modalities, may be worthwhile in this very difficult population. It's worth looking at this particular study and looking at their long-term outcomes, because I think that this may be a very interesting approach. Thank you.