An average of 2C5 posttransplantation sessions was also required.15 Lipshutz et?al.16 observed that the number of plasma exchange sessions depends on the initial isoagglutinin titers, ranging from 4 to 5 for a titer of 1 1:16 to 18 for a titer of 1 1:1024. group, while around 8 sessions were required for the Adsopak group before transplantation (p? ?0.001). The Glycosorb group was advantageous in terms of graft failure?because no rejection was noticed in these patients in their follow-up period. Three patients in the Adsopak group developed rejection (two had mixed rejection, and one had antibody-mediated rejection). Four patients died of R935788 (Fostamatinib disodium, R788) sepsis (three in the Glycosorb and one in the Adsopak group). Lower baseline serum creatinine level was achieved in the Glycosorb group. Conclusions Results of ABO-incompatible renal transplantation were satisfactory, and the use of immunoadsorption columns could effectively deplete antibody titers. Glycosorb columns were more efficient than Adsopak columns. Graft survival was better with Glycosorb. Posttransplant infections were a major cause of mortality. strong class=”kwd-title” Keywords: ABO-incompatible transplantation, Immunoadsorption columns, Adsopak, Glycosorb Introduction Renal transplantation is the best treatment form for patients with chronic kidney disease requiring renal replacement therapy.1 In ENOX1 developing countries such as India, transplant options are limited and ABO incompatibility remains an important limiting factor among?the living donors. It leads to rejection of around 35% living kidney donors.2 Living donor renal transplantation is traditionally planned in accordance with the rules of blood group compatibility. Unintentional breach of the ABO barrier has led to immediate or irreparable graft losses.3, 4 Since the last two decades, ABO-incompatible (ABOi) transplantation protocols have evolved from splenectomy to specific antibody removal by immunoadsorption (IA) techniques. ABOi renal transplantation is still uncommon in developing countries because of high cost, lack of experience and infrastructure, and risk of antibody-mediated rejection. ABOi transplantation protocols differ the world over with respect to antibody removal R935788 (Fostamatinib disodium, R788) techniques, accepted and target antibody titer, method of antibody detection, and immunosuppression maintenance.5 Most European preconditioning protocols are based on IA techniques using antigen-specific columns.6 Two types of antigen-specific IA columns are commercially available, Glycosorb?-ABO column which is a single-use column and ABO Adsopak? column which is reuseable. Both are low-molecular-weight carbohydrate columns with immobilized blood group A or B antigens linked to a sepharose matrix. These columns specifically deplete anti-A or anti-B antibodies, and their use together with anti-CD20 antibody administration has showed excellent results R935788 (Fostamatinib disodium, R788) on 5-year follow-up.7 The ABOi living donor renal transplantation program was started at our center in July 2013 and began using IA columns for the antibody depletion technique in January 2014. We present our experience of ABOi renal transplant using IA columns. We also have compared the efficacy of the two commercially available columns in India. Materials and methods I. Study design This is a single-center prospective study II. Study place The study was conducted in a tertiary care hospital in India. III. Study sample All consecutive ABOi renal transplants from January 2014 to February 2018 were analyzed. A total of 30 patients underwent ABOi renal transplantations, of which?28 underwent antibody depletion with immunoadsorption columns. IV. Inclusion criteria1. Patients suffering from chronic kidney disease stage 5D with no live related donor of compatible blood group. 2. Patients aged at least 18 years and able to give consent regarding ABOi renal transplantation. 3. Patients proposing a live related donor to whom he/she has a baseline antiCblood group titer 1:2048. 4. Patients vaccinated against hepatitis B?and pneumococcal disease at least 15 days before beginning desensitization. V. Exclusion criteria1. Patients suffering from an unstable cardiovascular condition. 2. Patients with any form of active bacterial, viral, or other infection. 3. Patients with complement-dependent cytotoxicity (CDC) or flow crossmatch positivity with the donor. 4. Patients with a known or suspected hereditary complement deficiency. 5. Patients with a known hypersensitivity to the treatment drug or any of its excipients. 6. Patients with a history of illicit drug use or alcohol abuse in the previous year. 7. Patients with any medical condition that might interfere with the patient’s participation in the study, pose an added risk for the patient, or.