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Kenan Keven, Sule Sengul, ABO-incompatible kidney transplantation: on-demand strategy, Nephrology Dialysis Transplantation, Volume 23, Issue 5, May 2008, Pages 1773–1774, https://doi.org/10.1093/ndt/gfm930
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Sir,
We read with great interest the recent article by Wilpert et al ., on the alternative strategy to scheduled post-transplant immunoadsorptions after ABO-incompatible renal transplantation [ 1 ]. After giving rituximab 4 weeks prior to scheduled transplantation, a triple immunosuppression regimen was started and antigen-specific immunoadsorptions were performed, until IgG-anti-A/B titers equalled 1:4 or less on the morning of transplantation. Wilpert et al . did not routinely perform immunoadsorption, unless antibody titers exceed pre-defined thresholds after transplantation. With this approach, 15 of 22 patients did not require post-operative immunoadsorption (post-tx IA). They concluded that immunoadsorbtion can be performed according to post-operative antibody titers in ABO-incompatible kidney transplantation.
In Table 2, there were three and five patients of living-related kidney transplantation in patients with post-tx IA and without post-tx IA, respectively. Were the rest of the patients living-unrelated kidney recipients? How many spouses, emotionally related or non-directed donors were there? Who covered the cost of these transplantations? Was there any analysis comparing the costs of ABO-mismatch and -match transplantation in this centre? The average dialysis time was 44 ± 32 months before the transplantation. Why is the duration of waiting in dialysis this long while there are living donors? Also, we noticed that 17 months after transplantation, the mean estimated glomerular filtration rates (eGFRs) (not creatinine-clearance) were 50 ml/min/1.73 m 2 (MDRD formula) in patients requiring post-tx IA and 46 ml/min/1.73 m 2 in patients without post-tx IA (Table 2). These are the mean levels; however, considering the number of patients, median levels should have been given with minimum and maximum levels. When looking at the median levels, eGFRs were 53 ml/min/1.73 m 2 in post-tx IA and 45 ml/min/1.73 m 2 in non-post-tx IA group. In this study, eGFR seems to be lower in both groups when compared with large study samples [ 2 ].
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