World J Nephrol Urol

World Journal of Nephrology and Urology, ISSN 1927-1239 print, 1927-1247 online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Nephrol Urol and Elmer Press Inc

Journal website https://wjnu.elmerpub.com

Original Article

Volume 14, Number 2, November 2025, pages 35-43

Successful Usage of Extracorporeal Plasma Perfusion Adsorption Devices Columns for Desensitization Through Immunoadsorption in End-Stage Renal Disease Patients for ABO-Incompatible Kidney Transplant

**Table 1.** Overview of Immunological Strategy in ABOiKT
Step	Description
ABOiKT: ABO-incompatible kidney transplantation; HLA: human leukocyte antigen; IA: immunoadsorption.
Donor-recipient mismatch	ABO blood group incompatibility
Pre-transplant evaluation	Blood group typing, HLA matching, antibody titers (IgG, IgM)
Desensitization initiation	Rituximab infusion, followed by IA or plasmapheresis
Surgical procedure	End-to-side vascular anastomosis under general anesthesia
Post-operative immunosuppression	Tacrolimus, mycophenolate, steroids, and monitoring of tac/titers/creatinine

Table 1. Overview of Immunological Strategy in ABOiKT

Step

Description

ABOiKT: ABO-incompatible kidney transplantation; HLA: human leukocyte antigen; IA: immunoadsorption.

Donor-recipient mismatch

ABO blood group incompatibility

Pre-transplant evaluation

Blood group typing, HLA matching, antibody titers (IgG, IgM)

Desensitization initiation

Rituximab infusion, followed by IA or plasmapheresis

Surgical procedure

End-to-side vascular anastomosis under general anesthesia

Post-operative immunosuppression

Tacrolimus, mycophenolate, steroids, and monitoring of tac/titers/creatinine

**Table 2.** Demographic and Clinical Parameters at Discharge
Patient number	Transplant date	Age (years)	Gender	CKD stage	Donor relationship	Recipient blood group	Donor blood group	Transplant
CKD: chronic kidney disease.
1	12/11/2022	46	F	Stage 5	Husband	B+	A+	Successful
2	13/01/2023	41	M	Stage 5	Father	O+	A+	Successful
3	03/07/2024	51	M	Stage 5	Wife	O+	B+	Successful
4	14/03/2024	45	F	Stage 5	Mother	B+	A+	Successful
5	1/10/2024	42	F	Stage 5	Sister	B+	A+	Successful
6	20/10/2021	45	F	Stage 5	Mother	A+	AB+	Successful
7	01/10/2024	30	M	Stage 5	Wife	O+	B+	Successful
8	02/05/2024	33	M	Stage 5	Brother	O+	A+	Successful
9	12/10/2021	41	M	Stage 5	Sister	B+	AB+	Successful
10	21/03/2024	32	M	Stage 5	Brother	B+	AB+	Successful
11	16/092022	33	M	Stage 5	Wife	A⁺	B+	Successful
12	29/04/2022	28	M	Stage 5	Mother	O+	A+	Successful
13	20/10/2021	44	F	Stage 5	Mother	A+	AB+	Successful
14	7/09/2021	40	M	Stage 5	Mother	B+	AB+	Successful
15	19/02/2020	35	M	Stage 5	Maternal uncle	B+	A+	Successful
16	13/04/2022	33	F	Stage 5	Father	A+	AB+	Successful
17	7/02/2022	23	M	Stage 5	Father	O+	B+	Successful
18	23/09/2021	39	M	Stage 5	Wife	O+	AB+	Successful
19	16/07/2021	61	M	Stage 5	Wife	O+	B+	Successful
20	31/01/2020	48	M	Stage 5	Wife	O+	B+	Successful
21	13/01/2023	44	M	Stage 5	Father	O+	A+	Successful

Table 2. Demographic and Clinical Parameters at Discharge

Patient number

Transplant date

Age (years)

Gender

CKD stage

Donor relationship

Recipient blood group

Donor blood group

Transplant

CKD: chronic kidney disease.

12/11/2022

Stage 5

Husband

B+

A+

Successful

13/01/2023

Stage 5

Father

O+

A+

Successful

03/07/2024

Stage 5

Wife

O+

B+

Successful

14/03/2024

Stage 5

Mother

B+

A+

Successful

1/10/2024

Stage 5

Sister

B+

A+

Successful

20/10/2021

Stage 5

Mother

A+

AB+

Successful

01/10/2024

Stage 5

Wife

O+

B+

Successful

02/05/2024

Stage 5

Brother

O+

A+

Successful

12/10/2021

Stage 5

Sister

B+

AB+

Successful

21/03/2024

Stage 5

Brother

B+

AB+

Successful

16/092022

Stage 5

Wife

A⁺

B+

Successful

29/04/2022

Stage 5

Mother

O+

A+

Successful

20/10/2021

Stage 5

Mother

A+

AB+

Successful

7/09/2021

Stage 5

Mother

B+

AB+

Successful

19/02/2020

Stage 5

Maternal uncle

B+

A+

Successful

13/04/2022

Stage 5

Father

A+

AB+

Successful

7/02/2022

Stage 5

Father

O+

B+

Successful

23/09/2021

Stage 5

Wife

O+

AB+

Successful

16/07/2021

Stage 5

Wife

O+

B+

Successful

31/01/2020

Stage 5

Wife

O+

B+

Successful

13/01/2023

Stage 5

Father

O+

A+

Successful

**Table 3.** Desensitization Protocol and Isoagglutinin Titers
Patient number	Immunoadsorption sessions	Column used	Pre-IgG titer	Pre-IgM titer	Post-IgG titer	Post-IgM titer
NA: data not available.
1	2	A	1:64	1:8	Nil	NA
2	2	A	1:128	1:32	1:2	NA
3	2	B	1:256	1:128	1:4	1:2
4	1	A	1:128	1:64	1:4	1:2
5	2	A	1:512	1:512	1:8	NA
6	1	B	1:32	1:4	1:2	Nil
7	2	B	1:1,024	1:512	1:4	1:4
8	2	A	1:512	1:512	1:8	1:2
9	1	A	1:32	Nil	1:2	NA
10	2	A	1:64	1:32	1:4	1:4
11	3	B	1:64	1:64	1:4	1:2
12	2	A	1:256	1:256	1:4	1:2
13	2	B	1:512	1:256	1:2	1:4
14	3	A	1:1,024	1:512	1:8	1:4
15	1	A	1:64	1:32	1:1	Nil
16	1	B	1:128	NA	1:2	NA
17	2	B	1:128	1:64	1:2	1:2
18	2	AB	-	-	-	-
		B	1:128	NA	1:2	NA
		A	1:64	NA	1:4	NA
19	2	B	1:128	1:128	1:2	1:1
20	2	B	1:128	1:64	1:2	1:2
21	2	A	1:128	1:256	1:2	1:2

Table 3. Desensitization Protocol and Isoagglutinin Titers

Patient number

Immunoadsorption sessions

Column used

Pre-IgG titer

Pre-IgM titer

Post-IgG titer

Post-IgM titer

NA: data not available.

1:64

1:8

Nil

1:128

1:32

1:2

1:256

1:128

1:4

1:2

1:128

1:64

1:4

1:2

1:512

1:8

1:32

1:4

1:2

Nil

1:1,024

1:512

1:4

1:512

1:8

1:2

1:32

Nil

1:2

1:64

1:32

1:4

1:64

1:4

1:2

1:256

1:4

1:2

1:512

1:256

1:2

1:4

1:1,024

1:512

1:8

1:4

1:64

1:32

1:1

Nil

1:128

1:2

1:128

1:64

1:2

1:128

1:2

1:64

1:4

1:128

1:2

1:1

1:128

1:64

1:2

1:128

1:256

1:2

**Table 4.** Post-Transplant Graft Function Indicators: Creatinine and Tacrolimus Levels at Discharge
Patient number	Days from admission to discharge	Last creatinine (mg/dL)	Tacrolimus (ng/mL)
1	12	0.77	8.2
2	11	1.09	24.9
3	9	0.98	7.30
4	9	0.6	16.75
5	10	0.93	13.91
6	8	0.71	9.54
7	10	1.44	6.19
8	9	0.74	7.12
9	9	1.7	6.4
10	9	0.85	6.6
11	11	1.44	9.67
12	21	1.89	8.10
13	6	1.2	10.6
14	10	0.97	22
15	9	1.26	22
16	10	0.77	8.1
17	9	1.49	14.2
18	6	1.59	11.8
19	11	2.61	5.64
20	10	1.19	9.2
21	11	1.09	24.9

Table 4. Post-Transplant Graft Function Indicators: Creatinine and Tacrolimus Levels at Discharge

Patient number

Days from admission to discharge

Last creatinine (mg/dL)

Tacrolimus (ng/mL)

0.77

8.2

1.09

24.9

0.98

7.30

0.6

16.75

0.93

13.91

0.71

9.54

1.44

6.19

0.74

7.12

1.7

6.4

0.85

6.6

1.44

9.67

1.89

8.10

1.2

10.6

0.97

1.26

0.77

8.1

1.49

14.2

1.59

11.8

2.61

5.64

1.19

9.2

1.09

24.9