PRETRANSPLANTATION IMMUNOADSORPTION THERAPY IN PATIENTS IMMUNIZED WITH HUMAN LYMPHOCYTE ANTIGEN - EFFECT OF TREATMENT AND 3 YEARS CLINICAL FOLLOW-UP OF GRAFTS

Sensitization against human lymphocyte antigen (HLA) occurs frequently in previously transplanted patients that lose a first cadaveric graft . To shorten their time on the waiting list and reduce the incidence o f early rejection in such patients, we performed immunoadsorption ther apy by a tryptophan column in 10 patients as an attempt to remove circ ulating antibodies prior to regrafting. Resynthesis of antibodies was suppressed with cyclophosphamide and prednisolone. Following the cours e of immunoadsorption therapy, the panel reactive antibodies (PRA) dec reased by more than 50% from the pretreatment values. In the present s tudy, 8 patients were transplanted with cadaveric renal grafts. At the time of follow-up, graft survival was 63% in these patients (2-36 mon ths post transplantation, mean 23 months). There was one incidence of acute rejection, one graft was lost within 48 h owing to renal artery thrombosis, and one was lost within 2 weeks as a result of stenosis. T he serum creatinine levels were down to near normal during the first 3 weeks in hospital (p < 0.0001) and remained at this level during the period of follow-up. We conclude that immunoadsorption might be a bene ficial pretransplantation therapy and an alternative to plasmapheresis in HLA-immunized patients awaiting kidney transplantation.