Treatment of large plasma volumes using specific immunoadsorption to desensitize ABO-incompatible kidney-transplant candidates
Background: ABO-incompatible (ABOi) kidney-transplantation has very good long-term results, i.e. similar to those observed for living-kidney ABO-compatible transplantation. This is because patients are desensitized at pretransplant using apheresis and rituximab therapy, with tacrolimus-based immunos...
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| Format: | Article |
| Language: | English |
| Published: |
Society of Diabetic Nephropathy Prevention
2016-07-01
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| Series: | Journal of Nephropathology |
| Subjects: | |
| Online Access: | https://nephropathol.com/PDF/JNP-5-90.pdf |
| _version_ | 1827948546933915648 |
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| author | Lionel Rostaing Asma Allal Arnaud del Bello Federico Sallusto Laure Esposito Nicolas Doumerc Bénédicte Debiol Audrey Delas Xavier Game Nassim Kamar |
| author_facet | Lionel Rostaing Asma Allal Arnaud del Bello Federico Sallusto Laure Esposito Nicolas Doumerc Bénédicte Debiol Audrey Delas Xavier Game Nassim Kamar |
| author_sort | Lionel Rostaing |
| collection | DOAJ |
| description | Background: ABO-incompatible (ABOi) kidney-transplantation has very good long-term results, i.e. similar to those observed for living-kidney ABO-compatible transplantation. This is because patients are desensitized at pretransplant using apheresis and rituximab therapy, with tacrolimus-based immunosuppression. Objectives: To assess the efficacy of a single, pretransplant (Day –1), specific immunoadsorption session using Glycosorb® columns (anti-A or anti-B; Glycorex Sweden) to treat large volumes of plasma (up to 18 L). Patients and Methods: Prospective single-center study evaluating 12 consecutive patients (6 males), aged 40 (23–59) years. Incompatibilities were A into 0 (8), B into 0 (3), and AB into 0 (1). Pretransplant desensitization relied on rituximab (D–30), tacrolimus, mycophenolic acid, and steroids (all started on D–13), and a single session of specific immunoadsorption on D–1. Immunoadsorption was coupled in tandem with a hemodialysis session. Results: Overall, 15 L (11–18) of plasma were treated per patient, i.e., 0.2 (0.11–0.36 L/kg). Isoagglutinin titers were 1/16 (1/5–1/64) before the procedure, decreasing after 6 hours to 1/5 (1/1–1/16 P = 0.008), and to 1/2 (1/1–1/8; P = 0.05) at completion of the session. The next day, i.e., the day of transplantation, there was no rebound of isoagglutinins [1/4 (1/1–1/5); P = ns]. The procedure was well tolerated with no side-effects and no significant changes in hemoglobin level, platelet counts, fibrinogen, or albumin levels. Conclusions: For ABOi kidney-transplantation, a single, longer, specific immunoadsorption session was very efficient at 1-day pre-transplantation with no rebound. These results should be confirmed when isoagglutinin titers are higher (≥120). |
| first_indexed | 2024-04-09T12:57:03Z |
| format | Article |
| id | doaj.art-61832baae4ea46b09ea61545ba3efeaa |
| institution | Directory Open Access Journal |
| issn | 2251-8363 2251-8819 |
| language | English |
| last_indexed | 2024-04-09T12:57:03Z |
| publishDate | 2016-07-01 |
| publisher | Society of Diabetic Nephropathy Prevention |
| record_format | Article |
| series | Journal of Nephropathology |
| spelling | doaj.art-61832baae4ea46b09ea61545ba3efeaa2023-05-13T11:32:52ZengSociety of Diabetic Nephropathy PreventionJournal of Nephropathology2251-83632251-88192016-07-0153909710.15171/jnp.2016.17JNP_20160708134734Treatment of large plasma volumes using specific immunoadsorption to desensitize ABO-incompatible kidney-transplant candidatesLionel Rostaing0Asma Allal1Arnaud del Bello2Federico Sallusto3Laure Esposito4Nicolas Doumerc5Bénédicte Debiol6Audrey Delas7Xavier Game8Nassim Kamar9Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, FranceDepartment of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, FranceDepartment of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, FranceDepartment of Urology, Andrology, and Transplantation, CHU Rangueil, Toulouse, FranceDepartment of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, FranceDepartment of Urology, Andrology, and Transplantation, CHU Rangueil, Toulouse, FranceEtablissement Français du Sang de Midi-Pyrénées, CHU Purpan, Toulouse, FranceLaboratory of Histopathology, CHU Rangueil, Toulouse, FranceUniversité Toulouse III Paul Sabatier, Toulouse, FranceDepartment of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, FranceBackground: ABO-incompatible (ABOi) kidney-transplantation has very good long-term results, i.e. similar to those observed for living-kidney ABO-compatible transplantation. This is because patients are desensitized at pretransplant using apheresis and rituximab therapy, with tacrolimus-based immunosuppression. Objectives: To assess the efficacy of a single, pretransplant (Day –1), specific immunoadsorption session using Glycosorb® columns (anti-A or anti-B; Glycorex Sweden) to treat large volumes of plasma (up to 18 L). Patients and Methods: Prospective single-center study evaluating 12 consecutive patients (6 males), aged 40 (23–59) years. Incompatibilities were A into 0 (8), B into 0 (3), and AB into 0 (1). Pretransplant desensitization relied on rituximab (D–30), tacrolimus, mycophenolic acid, and steroids (all started on D–13), and a single session of specific immunoadsorption on D–1. Immunoadsorption was coupled in tandem with a hemodialysis session. Results: Overall, 15 L (11–18) of plasma were treated per patient, i.e., 0.2 (0.11–0.36 L/kg). Isoagglutinin titers were 1/16 (1/5–1/64) before the procedure, decreasing after 6 hours to 1/5 (1/1–1/16 P = 0.008), and to 1/2 (1/1–1/8; P = 0.05) at completion of the session. The next day, i.e., the day of transplantation, there was no rebound of isoagglutinins [1/4 (1/1–1/5); P = ns]. The procedure was well tolerated with no side-effects and no significant changes in hemoglobin level, platelet counts, fibrinogen, or albumin levels. Conclusions: For ABOi kidney-transplantation, a single, longer, specific immunoadsorption session was very efficient at 1-day pre-transplantation with no rebound. These results should be confirmed when isoagglutinin titers are higher (≥120).https://nephropathol.com/PDF/JNP-5-90.pdfabo-incompatible kidney transplantationspecific immunoadsorptionglycosorb®large plasma volumes |
| spellingShingle | Lionel Rostaing Asma Allal Arnaud del Bello Federico Sallusto Laure Esposito Nicolas Doumerc Bénédicte Debiol Audrey Delas Xavier Game Nassim Kamar Treatment of large plasma volumes using specific immunoadsorption to desensitize ABO-incompatible kidney-transplant candidates Journal of Nephropathology abo-incompatible kidney transplantation specific immunoadsorption glycosorb® large plasma volumes |
| title | Treatment of large plasma volumes using specific immunoadsorption to desensitize ABO-incompatible kidney-transplant candidates |
| title_full | Treatment of large plasma volumes using specific immunoadsorption to desensitize ABO-incompatible kidney-transplant candidates |
| title_fullStr | Treatment of large plasma volumes using specific immunoadsorption to desensitize ABO-incompatible kidney-transplant candidates |
| title_full_unstemmed | Treatment of large plasma volumes using specific immunoadsorption to desensitize ABO-incompatible kidney-transplant candidates |
| title_short | Treatment of large plasma volumes using specific immunoadsorption to desensitize ABO-incompatible kidney-transplant candidates |
| title_sort | treatment of large plasma volumes using specific immunoadsorption to desensitize abo incompatible kidney transplant candidates |
| topic | abo-incompatible kidney transplantation specific immunoadsorption glycosorb® large plasma volumes |
| url | https://nephropathol.com/PDF/JNP-5-90.pdf |
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