PMID- 31367505
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20201001
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 11
IP  - 5
DP  - 2019 May 30
TI  - Therapeutic Immunoadsorption and Conventional Plasma Exchange in ABO-incompatible 
      Renal Transplant: An Exculpatory Evidence.
PG  - e4787
LID - 10.7759/cureus.4787 [doi]
LID - e4787
AB  - Aim The objective of this study was to compare the efficacy of immunoadsorption 
      (IA) with conventional therapeutic plasma-exchange (cTPE) in ABO-incompatible 
      (ABOi) renal transplant. Methods Data of patients from July 2015 to June 2017 
      (category-I, number of patients (N) = 11; IA+/-cTPE) on the average length of stay 
      (ALOS), number of cTPE/IA, antibody-titers (AT), creatinine, patient and graft 
      survival at one year were compared retrospectively with patients in period from 
      February 2012 to June 2015 (category-II, N = 29; cTPE only). AT of patients not 
      decreasing to less than one fold after two cTPE were shifted for IA. For patients 
      undergoing IA, real-time AT was done and IA stopped after target titer (TT <1:8) 
      was achieved. Post-transplant cTPE was done if, titers rebounded to >/=1:8. 
      Intravenous immunoglobulin (IVIG) was given after every cTPE/IA. Cost comparisons 
      were made. Results In category-I, seven patients (63.63%) were shifted to IA from 
      cTPE. The mean cTPE procedures in category I and II are 3.5 +/- 2.4 and 4.8 +/- 2.5, 
      respectively (p = 0.206). The mean IA procedures in category-I are 1.6 +/- 0.5. The 
      number of patients requiring post-operative TPE was less in category-I than 
      category-II, i.e., N = 5, 45.5% vs N = 20, 69%, respectively (p = 0.171). The 
      expense of IA in category-I vs cTPE in category-II was statistically not 
      significant (p = 0.422) but had significant lesser ALOS (p = 0.044). Expenses, 
      when a patient undergoes both cTPE and IA (category-I), are significantly higher 
      to category-II (p = 0.003). The two groups were comparable in AT, creatinine 
      value, graft and patient survival rates at one year. Conclusion Contrary to the 
      general judgment of IA being expensive than cTPE, this study shows equivalent 
      expenditures with comparable therapeutic outcomes.
FAU - Agrawal, Soma
AU  - Agrawal S
AD  - Transfusion Medicine, Indraprastha Apollo Hospitals, New Delhi, IND.
FAU - Chowdhry, Mohit
AU  - Chowdhry M
AD  - Transfusion Medicine, Indraprastha Apollo Hospitals, New Delhi, IND.
FAU - Makroo, Raj N
AU  - Makroo RN
AD  - Transfusion Medicine, Indraprastha Apollo Hospitals, New Delhi, IND.
FAU - Nayak, Sweta
AU  - Nayak S
AD  - Transfusion Medicine, Fortis Hospital, Faridabad, IND.
FAU - Gajulapalli, Shiva P
AU  - Gajulapalli SP
AD  - Transfusion Medicine, Indraprastha Apollo Hospitals, New Delhi, IND.
FAU - Thakur, Uday K
AU  - Thakur UK
AD  - Transfusion Medicine, Indraprastha Apollo Hospitals, New Delhi, IND.
FAU - Agrawal, Ankit
AU  - Agrawal A
AD  - Internal Medicine, Saint Peter's University Hospital - Rutgers Robert Wood 
      Johnson Medical School, New Brunswick, USA.
LA  - eng
PT  - Journal Article
DEP - 20190530
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC6666925
OTO - NOTNLM
OT  - abo incompatible
OT  - immunoadsorption
OT  - renal transplant
COIS- The authors have declared that no competing interests exist.
EDAT- 2019/08/02 06:00
MHDA- 2019/08/02 06:01
PMCR- 2019/05/30
CRDT- 2019/08/02 06:00
PHST- 2019/08/02 06:00 [entrez]
PHST- 2019/08/02 06:00 [pubmed]
PHST- 2019/08/02 06:01 [medline]
PHST- 2019/05/30 00:00 [pmc-release]
AID - 10.7759/cureus.4787 [doi]
PST - epublish
SO  - Cureus. 2019 May 30;11(5):e4787. doi: 10.7759/cureus.4787.