Use of immunoadsorption columns in ABO-incompatible renal transplantation: A prospective study at a tertiary care center in India

D Mukherjee; A K Hooda; A Jairam; Ranjith K Nair; Sourabh Sharma

doi:10.1016/j.mjafi.2019.08.005

Use of immunoadsorption columns in ABO-incompatible renal transplantation: A prospective study at a tertiary care center in India

Med J Armed Forces India. 2021 Jan;77(1):15-21. doi: 10.1016/j.mjafi.2019.08.005. Epub 2019 Dec 19.

Authors

D Mukherjee¹, A K Hooda², A Jairam³, Ranjith K Nair⁴, Sourabh Sharma⁵

Affiliations

¹ Senior Advisor (Med & Nephrology), Army Hospital (R&R), Delhi Cantt, India.
² Director General (Org & Pers), O/o DGAFMS, Ministry of Defence, 'M' Block, New Delhi 110001, India.
³ Consultant (Med & Nephrology), Command Hospital (Eastern Command), Kolkata, India.
⁴ Senior Advisor (Med & Nephrology), Command Hospital (Eastern Command), Kolkata, India.
⁵ Senior Resident (Med & Nephrology), Army Hospital (R&R), Delhi Cantt, India.

Abstract

Background: We present our experience of ABO-incompatible renal transplant using immunoadsorption (IA) columns. We have compared efficacy of two commercially available columns.

Methods: This single-center prospective study was conducted at Army Hospital Research and Referral, Delhi. All consecutive ABO-incompatible renal transplants from January 2014 to February 2018 were analyzed. Of 30 patients who underwent transplantations, 28 underwent antibody depletion with immunoadsorption columns. Of them, 14 cases were in the "Glycosorb group," while 14 in the "Adsopak group."

Results: The donors in the Adsopak group were older than those in the Glycosorb group (p < 0.05). Both groups had spousal donors in majority. The cutoff for the antibody titer was 1:8. The median titer in the Adsopak group was 128 (range, 1:4 to 1:2048), while that in the Glycosorb group was 24 (range, 1:8 to 1:128). All patients in the Glycosorb group had baseline titers ≤1:128, while 13 patients in the Adsopak group had baseline titers ≤1:512. Nil titer was achievable with Glycosorb® (50%,7/14) but not with Adsopak® (P < 0.01). Around 4 sessions were required for the Glycosorb group, while around 8 sessions were required for the Adsopak group before transplantation (p < 0.001). The Glycosorb group was advantageous in terms of graft failure because no rejection was noticed in these patients in their follow-up period. Three patients in the Adsopak group developed rejection (two had mixed rejection, and one had antibody-mediated rejection). Four patients died of sepsis (three in the Glycosorb and one in the Adsopak group). Lower baseline serum creatinine level was achieved in the Glycosorb group.

Conclusions: Results of ABO-incompatible renal transplantation were satisfactory, and the use of immunoadsorption columns could effectively deplete antibody titers. Glycosorb columns were more efficient than Adsopak columns. Graft survival was better with Glycosorb. Posttransplant infections were a major cause of mortality.

Keywords: ABO-incompatible transplantation; Adsopak; Glycosorb; Immunoadsorption columns.