A Critical Comparative Analysis of Immunoadsorption and Conventional Plasma Exchange in Preconditioning of ABO-incompatible Renal Transplant Cases

ABO-incompatible renal transplants often require expensive pre-transplant conditioning using therapeutic apheresis (TA) procedures to reduce the titers of isoagglutinins in the recipients, which may have adverse effects on the graft acceptance and survival. We undertook this analysis to compare two most commonly used modalities of TA: Immunoadsorption (IA) and conventional plasma exchange (cTPE). This retrospective analytical study compares four cases of ABO-incompatible renal transplant performed at our center. IA and cTPE were employed in two cases each, respectively. Economic burden for each case was calculated and compared. Cut-off titer was considered as ≤8 prior to renal transplant. If the economic burden of the cases with a starting isoagglutinin titer of 128, using cTPE as a pre-conditioning modality is considered to be ‘C’, the economic burden of cases with a starting isoagglutinin titer of 256 was estimated to be ‘1.33xC’. Similarly for cases where IA was used as the modality for pre-conditioning, economic burden was calculated to be ‘0.75xC’ for cases with a starting iso-agglutinin titer of 128 and ‘1xC’ for cases with a starting iso-agglutinin titer of 256. The authors concluded that the economic burden for using IA procedures for pre-conditioning in ABO-incompatible renal transplants may be equal to or less than that of using cTPE procedures at higher iso-agglutinin titers of ≥128.