Article

Does immunosuppressive pharmacotherapy affect isoagglutinin titers?

Department of Surgery, Tainan Hospital, Taiwan.
Transplantation Proceedings (impact factor: 1). 11/2008; 40(8):2685-7. DOI:10.1016/j.transproceed.2008.08.018
Source: PubMed

ABSTRACT Preoperative reduction of isoagglutinins leads to successful ABO-incompatible (ABOi) renal transplantation. The strategy includes pretransplantation plasmapheresis, more potent immunosuppressive drugs, splenectomy, and anti-CD20 antibody. It has been reported that low isoagglutinin antibody titers posttransplant were observed among ABOi renal transplants with favorable outcome. The isoagglutinin titers may increase slightly when plasmapheresis is discontinued; however, it never returns to the pretreatment level under immunosuppressive therapy. This raises the question of what occurs to the isoagglutinin titer in ABO-compatible renal transplants under maintenance immunosuppressive pharmacotherapy.
We analyzed 10 renal transplant recipients, including seven living and three cadaveric donors. Patients were treated with basiliximab (20 mg) intravenously on day 0 and day 4. Maintenance immunosuppressive therapy involved a calcineurin inhibitor, mycophenolate mofetil, and steroid. Anti-human globulin isoagglutinin titers were routinely examined 1 day before and day 0 and 1, 2, 3, 4, 8, 12, and 24 weeks posttransplant. No ALG or intravenous immunoglobulin or plasmapheresis treatment was provided in the follow-up period.
Our preliminary data showed nearly no influence on isoagglutinin titer levels in 6-month follow-up under maintenance immunosuppressive therapy. In addition, no significant difference in isoagglutinin titer was observed between tacrolimus and cyclosporine groups.
Maintenance immunosuppressive pharmacotherapy did not affect isoagglutinin titer levels in ABO-compatible kidney transplants. Further study is needed to investigate the mechanisms of persistent low-level isoagglutinin titers among successful ABOi renal transplantation patients.

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Keywords

24 weeks posttransplant
 
ABO-compatible kidney transplants
 
Anti-human globulin isoagglutinin titers
 
cadaveric donors
 
calcineurin inhibitor
 
day 4. Maintenance immunosuppressive therapy
 
favorable outcome
 
immunosuppressive therapy
 
intravenous immunoglobulin
 
isoagglutinin titer
 
isoagglutinin titer levels
 
low isoagglutinin antibody titers posttransplant
 
maintenance immunosuppressive pharmacotherapy
 
maintenance immunosuppressive therapy
 
persistent low-level isoagglutinin titers
 
plasmapheresis treatment
 
potent immunosuppressive drugs
 
Preoperative reduction
 
pretreatment level
 
successful ABOi renal transplantation patients
 

J-P Chuang