Agrawal Soma, Chowdhry Mohit, Makroo Raj N, Nayak Sweta, Gajulapalli Shiva P, Thakur Uday K, Agrawal Ankit
Transfusion Medicine, Indraprastha Apollo Hospitals, New Delhi, IND.
Transfusion Medicine, Fortis Hospital, Faridabad, IND.
Cureus. 2019 May 30;11(5):e4787. doi: 10.7759/cureus.4787.
Aim The objective of this study was to compare the efficacy of immunoadsorption (IA) with conventional therapeutic plasma-exchange (cTPE) in ABO-incompatible (ABOi) renal transplant. Methods Data of patients from July 2015 to June 2017 (category-I, number of patients (N) = 11; IA±cTPE) on the average length of stay (ALOS), number of cTPE/IA, antibody-titers (AT), creatinine, patient and graft survival at one year were compared retrospectively with patients in period from February 2012 to June 2015 (category-II, N = 29; cTPE only). AT of patients not decreasing to less than one fold after two cTPE were shifted for IA. For patients undergoing IA, real-time AT was done and IA stopped after target titer (TT <1:8) was achieved. Post-transplant cTPE was done if, titers rebounded to ≥1:8. Intravenous immunoglobulin (IVIG) was given after every cTPE/IA. Cost comparisons were made. Results In category-I, seven patients (63.63%) were shifted to IA from cTPE. The mean cTPE procedures in category I and II are 3.5 ± 2.4 and 4.8 ± 2.5, respectively (= 0.206). The mean IA procedures in category-I are 1.6 ± 0.5. The number of patients requiring post-operative TPE was less in category-I than category-II, i.e., = 5, 45.5% vs = 20, 69%, respectively (= 0.171). The expense of IA in category-I vs cTPE in category-II was statistically not significant (= 0.422) but had significant lesser ALOS (= 0.044). Expenses, when a patient undergoes both cTPE and IA (category-I), are significantly higher to category-II (= 0.003). The two groups were comparable in AT, creatinine value, graft and patient survival rates at one year. Conclusion Contrary to the general judgment of IA being expensive than cTPE, this study shows equivalent expenditures with comparable therapeutic outcomes.
目的 本研究的目的是比较免疫吸附（IA）与传统治疗性血浆置换（cTPE）在ABO血型不相容（ABOi）肾移植中的疗效。方法 回顾性比较2015年7月至2017年6月（I类，患者数量（N）=11；IA±cTPE）患者在平均住院时间（ALOS）、cTPE/IA次数、抗体滴度（AT）、肌酐、患者及移植肾1年生存率等方面的数据，与2012年2月至2015年6月期间（II类，N = 29；仅cTPE）的患者进行对比。经两次cTPE后AT未降至低于1倍的患者转至IA治疗。对于接受IA治疗的患者，进行实时AT检测，达到目标滴度（TT <1:8）后停止IA治疗。如果滴度反弹至≥1:8，则进行移植后cTPE治疗。每次cTPE/IA后给予静脉注射免疫球蛋白（IVIG）。进行成本比较。结果 在I类中，7名患者（63.63%）从cTPE转至IA治疗。I类和II类中cTPE的平均次数分别为3.5±2.4和4.8±2.5（P = 0.206）。I类中IA的平均次数为1.6±0.5。I类中术后需要TPE的患者数量少于II类，即分别为5例（45.5%）和20例（69%）（P = 0.171）。I类中IA的费用与II类中cTPE的费用在统计学上无显著差异（P = 0.422），但ALOS显著更短（P = 0.044）。当患者同时接受cTPE和IA治疗（I类）时，费用显著高于II类（P = 0.003）。两组在AT、肌酐值、移植肾及患者1年生存率方面具有可比性。结论 与IA比cTPE昂贵的一般判断相反，本研究表明两者费用相当且治疗效果可比。
