ABO-incompatible kidney transplant recipients have a higher bleeding risk after antigen-specific immunoadsorption

Abstract

SummaryPretransplant removal of antiblood group ABO antibodies is the cornerstone of all current ABO-incompatible (ABOi) transplantation programmes. In our protocol, plasmapheresis (PP) is performed with a plasmafilter followed by immunoadsorption (IA) of anti-ABO antibodies. The bleeding complications of this technique are not known. We analysed the data of all 65 consecutive ABOi kidney transplantations between March 2006 and October 2013 and compared these with matched 130 ABO-compatible (ABOc) kidney transplantations. Cases differed from controls in the pre-operative regimen, which included IA-PP and rituximab, tacrolimus, mycophenolate mofetil, prednisone and immunoglobulines. Data on platelet count, blood loss and red blood cell (EC) transfusions during 48 h postoperatively were collected. ABOi patients received EC transfusions more frequently than controls (29% vs. 12%, P = 0.005). Intra-operative blood loss was higher (544 vs. 355 ml, P < 0.005) and they experienced more major bleeding (≥3 EC within 24 h, 15% vs. 2%, P < 0.0005). Platelet count decreased by 28% after the pre-operative IA. In a multivariate model, only the number of pre-operative IAs was associated with the number of ECs given (OR per IA 1.9, P < 0.05). ABOi kidney transplant recipients have a high postoperative bleeding risk, correlating with the number of pre-operative IA sessions performed.

De novo mTOR inhibitor‐based immunosuppression in ABO‐incompatible kidney transplantation

“…Only one re‐operation was carried out due to bleeding in a patient on anticoagulation due to arrhythmia. This is in opposition to data of de Weerd et al proposing a higher bleeding risk in ABO i patients .…”

ABO-Incompatible Kidney Transplantation

“…A higher bleeding risk was also found in a cohort of pediatric kidney transplant recipients with two major bleeding episodes in three patients, which was attributed to the unspecific binding of coagulation factors during repeated IA (30). This assumption is supported by the findings of de Weerd et al who found a significant correlation between the number of pretransplant apheresis treatments and the peri- and posttransplant bleeding risk (31). …”

Long-term Outcomes of ABO-Incompatible Living Donor Kidney Transplantation: A Comparative Analysis

“…However, there is a concern about an increased risk of postoperative bleeding complications, which can be attributed to the loss of coagulation factors during plasmapheresis and the anticoagulants used in plasmapheresis sessions [9,16,17]. de Weerd et al compared the amount of intraoperative blood loss and the need for red blood cell transfusion between 65 ABO-i and 130 matched ABO-c patients [18]. A median of 4 sessions of plasmapheresis were performed before KT, with a range of 0 to 10 sessions depending on the initial isoagglutinin titer and the titer reduction during plasmapheresis.…”