Abstract: SA-PO1163
Reuse of Immunoabsorption Columns in ABO-Incompatible(ABOi) Kidney Transplantation: A Single-Center Experience
Session Information
- Transplantation: Clinical - Rejection, Recurrent Disease, Incompatibility
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Bhalla, Anil, Sir Ganga Ram Hospital , New Delhi, India
- Meena, Priti, Sir Ganga Ram Hospital , New Delhi, India
- Rana, Devinder S., Sir Ganga Ram Hospital , New Delhi, India
- Gupta, Ashwani, Sir Ganga Ram Hospital , New Delhi, India
- Malik, Manish, Sir Ganga Ram Hospital and GRIPMER, New Delhi, India
- Gupta, Anurag, Synegy Hospital, Uttarakhand, India
- Bhargava, Vinant, Sir Ganga Ram Hospital , New Delhi, India
- Tiwari, Vaibhav, Sir Ganga Ram Hospital , New Delhi, India
- Anand, Yogeshman, Sir Ganga Ram Hospital , New Delhi, India
Background
ABO-incompatible (ABOi) Kidney Transplantation has results comparable to ABO compatible transplantation. This is because patients are desensitized at the pre-transplant stage using apheresis & Rituximab therapy with tacrolimus (TAC) based immunosuppression. In some patients, baseline titers are very high and repeated plasma exchange sessions also fail to bring titer to the desired level. Immunoadsorption (IA) technique is very effective in reducing titers in such cases. But, IA therapy is quite expensive, hence we have tried to reuse the filter to see the effectiveness.
Methods
190 ABOi transplants have been performed at our center since 2012.Patients received Rituximab and triple immunosuppression. Baseline IgG & IgM were tested with gel method and it ranged from 1: 2 to 1: 1024. The antigen-specific IA technique was used in 64 patients.Two types of IA filters were used Glycorex – glycosorb & Adsopak. IA columns were reused after regeneration. No. of column reuse, adverse events, and Anti A / Anti B antibody titers were assessed. Glycosorb filter was processed by rising with 1000ml saline and sterilized with Ethylene trioxide(ETO). Adsopac column was reused by different regeneration technique using saline wash,acidic solution followed by buffer and alkaline solution and regeneration solution(sodium azide):The column was placed at 2° to 8°C.Antibody titers were estimated in the blood taken 10 minutes before the end of the procedure from the line immediately after the Column.Negative or low antibody titer indicated efficient antibody removal at the end of treatment &despite reuse of the columns.Columns were used maximally for 3 times.
Results
64 ABOi patients underwent antigen-specific IA and could be transplanted.In 4 patients, the titers did not come to target levels and these had to subject to therapeutic plasma exchange to achieve the target levels.Incidence of hypotension, fever with rigors & failure to bring down the titer was significantly higher in adsopak filter as compared to Glycorex filter. Column reuse resulted in a cost saving of 5000 to 10,000 USD per patient.
Conclusion
Although IA technique is very effective, it is expensive and the cost of treatment increases considerably. Reuse sessions were tolerated well and titer could be reduced to target levels.