Immunoadsorption-Based HLA Desensitization in Patients Awaiting Deceased Donor Kidney Transplantation: An Interventional, Non-Randomised, Single Cohort Study

Whether immunoadsorption (IADS) as part of desensitization protocols could facilitate deceased donor kidney transplantation (KT) in highly sensitized (HS) patients remains to be proven. We retrospectively analyzed our IADS based protocol for KTs between 2013 and 2018. Fifteen HS (age 52 years [40–56]) were included. Waiting time before was 6 [5–10] the interval initiation KT 5 months [1–12] 14 transplanted patients. Nine had prior KT. Calculated panel reactive antibody decreased significantly during (99.3% [92.5–99.9] vs. 79.4% [56.7–81.9]; p = 0.004). Death-censored graft survival 85.7% at 1 2 post-transplantation. One-year median plasma creatinine level 135 µmol/L [111–202]. Six developed active mediated rejection (ABMR) year, with a delay 13 days [11–26]. Eight severe infections, including two fatal outcomes. Finally, compared 93% who received receiving KT, only 43% control similar characteristics underwent transplantation. However, no difference found overall probability being alive functioning end follow-up. The results indicate that IADS-based strategy not effective due high rate ABMR infectious complications which pose challenge its universalization.