Enhancing Success in the ABO-Incompatible Kidney Transplantation: A Case Report

TL;DR

This case report describes a successful ABO-incompatible kidney transplant using immunoadsorption to reduce antibody levels.

Contribution

The report compares two IA column brands in achieving target antibody levels for ABOi kidney transplantation.

Findings

Glycosorb® ABO reduced anti-B titers but showed rebound after plasmapheresis.

Vitrosorb SECORIM®-ABO successfully lowered anti-B titers to enable transplantation.

IA columns were well tolerated and effective in desensitization for ABOi KT.

Abstract

Kidney transplantation is the preferred treatment for end-stage renal disease (ESRD); however, ABO incompatibility (ABOi) poses challenges due to increased graft rejection risk. Desensitization strategies, including immunoadsorption (IA), aim to overcome ABOi barriers. The objective of this case report was to present the initial findings and patient outcomes of ABOi kidney transplantation (KT) using two different brands of IA columns (Glycosorb® ABO and SECORIM®-ABO) in reducing isoagglutinin titers to the desired target level.

We present a case report of a 51-year-old male with ESRD secondary to diabetic kidney disease who underwent desensitization for ABOi KT, involving rituximab administration followed by IA using Glycosorb® and Vitrosorb SECORIM®-ABO columns and plasmapheresis (PP). Glycosorb® ABO column decreased anti-B titers from an initial level of 1:128/1:128 to 1:64/1:64 (target range ≤1:8); however, the titers rebounded to 1:64 following the fourth session of PP. Subsequent use of Vitrosorb SECORIM®-ABO column achieved target titers of 1:4, enabling successful transplantation with satisfactory graft function. Monitoring included anti-B IgG/IgM titer levels post IA columns, IA column reuse, kidney function, and adverse events. The IA columns were well tolerated. Desensitization using IA columns effectively reduced anti-B titers, facilitating successful ABOi KT.