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TransplantationZeitschriftTransplantationsmedizin3/2010Mathis, S. et al.

IgG Apheresis for ABO-incompatible Kidney Transplantation: A Systematic Review Shows Insufficient Evidence on Efficacy and Safety

S. Mathis, R. Winkler, S. Geiger-Gritsch, T. Mittermayr

Abstract
Organ recipients often have to wait for many years [1]. One effort to increase the number of available donators is crossing the borders of ABO-compatibility. This approach has been followed over the last 4 decades [2-11]. One specific method to enable kidney transplantations classified as incompatible is a selective removal of anti blood group antibodies by a preceding selective immunoadsorption. On the occasion of a suggestion to add the service of selective anti-ABO-IgG immunoadsorption to enable kidney transplantation across ABO borders to the list of generally reimbursed clinical health services in Austria this systematic review revealed the evidence for the use of this technology.
A systematic search in medical databases (Medline via Ovid, Embase, The Cochrane Library) and HTA databases was performed and articles were selected according to defined inclusion criteria. Reviewing the literature showed about 100 cases where this health technology was applied reported in 8 studies. Beside promising results, the analysed quality of the published evidence is very low and risk of flawed conclusions is high. According to the evaluation method of GRADE the evidence is too weak to make a well-founded positive recommendation. In particular there are no studies that directly compare patient relevant options (e.g.: Extension of donator programs, acceptance of longer waiting time). To evaluate the net benefit further scientific research is still necessary.

Key words: selective immunoadsorption, ABO incompatibility, renal transplantation, immune suppression, apheresis, blood group antibody, haemodialysis


Dr. DI Stefan Mathis
Health Technology Assessment
(LBI-HTA)
Ludwig Boltzmann Institut
Garnisongasse 7/20
A-1090 Wien
Österreich
E-Mail:
stefan.mathis@bitte-keinen-spamhta.lbg.ac.at


 























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