Non-antigen-specific Immunoadsorption Is a Risk Factor for Severe Postoperative Infections in ABO-Incompatible Kidney Transplant Recipients
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...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2024-03-01
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| Series: | Transplant International |
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| Online Access: | https://www.frontierspartnerships.org/articles/10.3389/ti.2024.12263/full |
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| author | Laura Matuschik Gabriel Seifert Katrin Lammich Philipp Holzner Yakup Tanriver Stefan Fichtner-Feigl Gerd Walz Johanna Schneider Bernd Jänigen |
| author_facet | Laura Matuschik Gabriel Seifert Katrin Lammich Philipp Holzner Yakup Tanriver Stefan Fichtner-Feigl Gerd Walz Johanna Schneider Bernd Jänigen |
| author_sort | Laura Matuschik |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-24T13:20:05Z |
| format | Article |
| id | doaj.art-210c98364aaf47f281e92054179e4820 |
| institution | Directory Open Access Journal |
| issn | 1432-2277 |
| language | English |
| last_indexed | 2024-04-24T13:20:05Z |
| publishDate | 2024-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Transplant International |
| spelling | doaj.art-210c98364aaf47f281e92054179e48202024-04-04T16:17:33ZengFrontiers Media S.A.Transplant International1432-22772024-03-013710.3389/ti.2024.1226312263Non-antigen-specific Immunoadsorption Is a Risk Factor for Severe Postoperative Infections in ABO-Incompatible Kidney Transplant RecipientsLaura Matuschik0Gabriel Seifert1Katrin Lammich2Philipp Holzner3Yakup Tanriver4Stefan Fichtner-Feigl5Gerd Walz6Johanna Schneider7Bernd Jänigen8Department of General and Visceral Surgery, Section of Transplant Surgery, Faculty of Medicine, Medical Center–University of Freiburg, Freiburg, GermanyDepartment of General and Visceral Surgery, Section of Transplant Surgery, Faculty of Medicine, Medical Center–University of Freiburg, Freiburg, GermanyDepartment of General and Visceral Surgery, Section of Transplant Surgery, Faculty of Medicine, Medical Center–University of Freiburg, Freiburg, GermanyDepartment of General and Visceral Surgery, Section of Transplant Surgery, Faculty of Medicine, Medical Center–University of Freiburg, Freiburg, GermanyDepartment of Medicine IV, Faculty of Medicine, Medical Center–University of Freiburg, Freiburg, GermanyDepartment of General and Visceral Surgery, Section of Transplant Surgery, Faculty of Medicine, Medical Center–University of Freiburg, Freiburg, GermanyDepartment of Medicine IV, Faculty of Medicine, Medical Center–University of Freiburg, Freiburg, GermanyDepartment of Medicine IV, Faculty of Medicine, Medical Center–University of Freiburg, Freiburg, GermanyDepartment of General and Visceral Surgery, Section of Transplant Surgery, Faculty of Medicine, Medical Center–University of Freiburg, Freiburg, GermanyABO-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.https://www.frontierspartnerships.org/articles/10.3389/ti.2024.12263/fullABO-incompatible kidney transplantationcomplicationsimmunoadsorptioninfectionsmortality |
| spellingShingle | Laura Matuschik Gabriel Seifert Katrin Lammich Philipp Holzner Yakup Tanriver Stefan Fichtner-Feigl Gerd Walz Johanna Schneider Bernd Jänigen Non-antigen-specific Immunoadsorption Is a Risk Factor for Severe Postoperative Infections in ABO-Incompatible Kidney Transplant Recipients Transplant International ABO-incompatible kidney transplantation complications immunoadsorption infections mortality |
| title | Non-antigen-specific Immunoadsorption Is a Risk Factor for Severe Postoperative Infections in ABO-Incompatible Kidney Transplant Recipients |
| title_full | Non-antigen-specific Immunoadsorption Is a Risk Factor for Severe Postoperative Infections in ABO-Incompatible Kidney Transplant Recipients |
| title_fullStr | Non-antigen-specific Immunoadsorption Is a Risk Factor for Severe Postoperative Infections in ABO-Incompatible Kidney Transplant Recipients |
| title_full_unstemmed | Non-antigen-specific Immunoadsorption Is a Risk Factor for Severe Postoperative Infections in ABO-Incompatible Kidney Transplant Recipients |
| title_short | Non-antigen-specific Immunoadsorption Is a Risk Factor for Severe Postoperative Infections in ABO-Incompatible Kidney Transplant Recipients |
| title_sort | non antigen specific immunoadsorption is a risk factor for severe postoperative infections in abo incompatible kidney transplant recipients |
| topic | ABO-incompatible kidney transplantation complications immunoadsorption infections mortality |
| url | https://www.frontierspartnerships.org/articles/10.3389/ti.2024.12263/full |
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