Tiwari Vaibhav, Gupta Anurag, Divyaveer Smita, Bhargava Vinant, Malik Manish, Gupta Ashwani, Bhalla Anil K, Rana D S
Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India.
Department of Nephrology, PGIMER, Chandigarh, India.
Indian J Nephrol. 2021 Jan-Feb;31(1):33-38. doi: 10.4103/ijn.IJN_373_19. Epub 2020 Nov 7.
Selective immunoadsorption (IA) is a technique to remove preformed Anti-ABO antibodies in ABO-incompatible renal transplants (ABOiRT). Since the cost of a single IA column is high and single use rarely achieves the target anti-ABO titers, its use is not widely spread. We studied the safety and efficacy of the reuse of IA columns in ABOiRT.
Single-center, retrospective analysis of all patients who underwent ABOiRT with IA column reuse from January 2016 to July 2018. The column was reused after sterilization with ethylene oxide and flushed with normal saline before use. Target titers (IgG) were 1:4 preoperatively. Baseline IgG titers, plasma volume processed in each session, postoperative titer rebound were recorded. The primary outcome was IgG titer reduction after each use and adverse reaction during the IA column reuse. Patients were followed up until 1 year.
16 patients underwent ABOiRT using IA columns. Baseline IgG titer ranged from 1:32 to 1:512. Reuse of IA column was done 23 times and underwent 2 reuse for 9 times. The average plasma volume treated was 22 L. Efficacy of the IA column in log titer reduction of anti-ABO titer was 4 logs after the first use, 3 logs after 1 reuse, and 1.5 logs after 2 reuse. 12 (75%) patients successfully reached the target IgG titer of ≤1:4 solely with column reuse. One patient received a single session of plasma exchange before transplantation. Postoperatively, one patient received one session of plasma exchange due to a rebound in anti-ABO antibodies. No serious side effects were noted during the reuse.
IA column reuse up to two times showed efficacy in the successful reduction of antibody titers. Column reuse was not associated with any significant side effects.
选择性免疫吸附（IA）是一种在ABO血型不相容肾移植（ABOiRT）中去除预先形成的抗ABO抗体的技术。由于单个IA柱成本高昂，且单次使用很少能达到目标抗ABO滴度，因此其应用并不广泛。我们研究了IA柱重复使用在ABOiRT中的安全性和有效性。
对2016年1月至2018年7月间所有接受IA柱重复使用的ABOiRT患者进行单中心回顾性分析。该柱用环氧乙烷灭菌后重复使用，使用前用生理盐水冲洗。术前目标滴度（IgG）为1:4。记录基线IgG滴度、每次治疗的血浆量、术后滴度反弹情况。主要结局是每次使用后IgG滴度降低情况以及IA柱重复使用期间的不良反应。对患者随访至1年。
16例患者接受了使用IA柱的ABOiRT。基线IgG滴度范围为1:32至1:512。IA柱重复使用23次，其中9次进行了2次重复使用。平均处理血浆量为22L。IA柱首次使用后抗ABO滴度对数降低的疗效为4个对数，1次重复使用后为3个对数，2次重复使用后为1.5个对数。12例（75%）患者仅通过柱重复使用就成功达到了≤1:4的目标IgG滴度。1例患者在移植前接受了一次血浆置换。术后，1例患者因抗ABO抗体反弹接受了一次血浆置换。重复使用期间未观察到严重副作用。
IA柱重复使用两次显示出成功降低抗体滴度的效果。柱重复使用未伴有任何明显副作用。
