PDF(Pubmed)
Abstract：
ABO-incompatible (ABOi) living kidney transplantation (KTx) is an established procedure to address the demand for kidney transplants with outcomes comparable to ABO-compatible KTx. Desensitization involves the use of immunoadsorption (IA) to eliminate preformed antibodies against the allograft. This monocentric retrospective study compares single-use antigen-selective Glycosorb® ABO columns to reusable non-antigen-specific Immunosorba® immunoglobulin adsorption columns regarding postoperative infectious complications and outcome. It includes all 138 ABOi KTx performed at Freiburg Transplant Center from 2004-2020. We compare 81 patients desensitized using antigen-specific columns (sIA) to 57 patients who received IA using non-antigen-specific columns (nsIA). We describe distribution of infections, mortality and allograft survival in both groups and use Cox proportional hazards regression to test for the association of IA type with severe infections. Desensitization with nsIA tripled the risk of severe postoperative infections (adjusted HR 3.08, 95% CI: 1.3-8.1) compared to sIA. nsIA was associated with significantly more recurring (21.4% vs. 6.2%) and severe infections (28.6% vs. 8.6%), mostly in the form of urosepsis. A significantly higher proportion of patients with sIA suffered from allograft rejection (29.6% vs. 14.0%). However, allograft survival was comparable. nsIA is associated with a two-fold risk of developing a severe postoperative infection after ABOi KTx.
摘要：
ABO不相容（ABOi）活体肾移植（KTx）是满足肾移植需求的既定程序，其结果与ABO相容的KTx相当。脱敏包括使用免疫吸附(IA)来消除针对同种异体移植物的预先形成的抗体。这项单中心回顾性研究比较了一次性使用的抗原选择性Glycosorb®ABO柱与可重复使用的非抗原特异性Immunosorba®免疫球蛋白吸附柱的术后感染并发症和结果。它包括2004年至2020年在弗莱堡移植中心进行的所有138次ABOiKTx。我们比较了使用抗原特异性柱（sIA）脱敏的81例患者与使用非抗原特异性柱（nsIA）接受IA的57例患者。我们描述了感染的分布，两组的死亡率和同种异体移植物存活率，并使用Cox比例风险回归检验IA型与严重感染的相关性。与sIA相比，nsIA脱敏使严重术后感染的风险增加了两倍（调整后的HR3.08，95％CI：1.3-8.1）。nsIA与明显更多的复发相关(21.4%与6.2％）和严重感染（28.6％vs.8.6%），主要是尿脓毒血症。sIA患者发生同种异体移植排斥反应的比例明显更高(29.6%vs.14.0%）。然而,同种异体移植存活率相当。nsIA与ABOiKTx术后发生严重术后感染的两倍风险相关。
