An in vitro comparison of intra-operative isohemagglutinin and human leukocyte antigen removal techniques in pediatric heart transplantation
Background: Highly sensitized pediatric patients awaiting heart transplantation experience longer wait times and thus higher waitlist mortality. Similarly, children less than 2 years of age have increased waitlist times and mortality when compared to their older peers. To improve the likelihood of s...
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| Format: | Article |
| Language: | English |
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EDP Sciences
2023-12-01
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| Series: | The Journal of ExtraCorporeal Technology |
| Subjects: | |
| Online Access: | https://ject.edpsciences.org/articles/ject/full_html/2023/04/ject230007/ject230007.html |
| _version_ | 1797294837897101312 |
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| author | Hayes Emily A. Walczak Ashley B Goodhue Meyer Erin Nicol Kathleen Deitemyer Matthew Duffy Vicky Moore Padilla Michelle Gajarski Robert J. Nandi Deipanjan |
| author_facet | Hayes Emily A. Walczak Ashley B Goodhue Meyer Erin Nicol Kathleen Deitemyer Matthew Duffy Vicky Moore Padilla Michelle Gajarski Robert J. Nandi Deipanjan |
| author_sort | Hayes Emily A. |
| collection | DOAJ |
| description | Background: Highly sensitized pediatric patients awaiting heart transplantation experience longer wait times and thus higher waitlist mortality. Similarly, children less than 2 years of age have increased waitlist times and mortality when compared to their older peers. To improve the likelihood of successful transplantation in these patients, various strategies have been utilized, including peri-operative plasmapheresis. However, limited data exists comparing plasmapheresis techniques for antibody reduction. This study’s aim was to compare the in vitro magnitude of isohemagglutinin titers (IT) and human leukocyte antigen (HLA) antibody removal and the time required between membrane-based plasmapheresis (MP) and centrifuge-based plasmapheresis (CP) incorporated into the extracorporeal (EC) circuit. Methods: Two MP (Prismaflex) and two CP (Spectra Optia, Terumo BCT) circuits were incorporated into four separate EC circuits primed with high titer, highly sensitized type O donor whole blood. Assays were performed to determine baseline IT and anti-HLA antibodies and then at 30-minute increments until completion of the run (two plasma volume exchanges) at two hours. Results: There was a decrease in anti-A and anti-B IgM and IgG titers with both MP and CP. Mean anti-A and anti-B titer reduction was by 4.625 titers (93.7% change) and 4.375 titers (93.8% change) using MP and CP, respectively. At 2 h of apheresis, CP reduced 62.5% of all ITs to ≤ 1:4, while MP reduced 50% of ITs to ≤ 1:4. Additionally, reduction of anti-HLA class II antibody to mean fluorescence intensity (MFI) <3000 was achieved with both MP and CP. At 2 h of apheresis, CP reduced MFI by 2–3.5 fold and MP reduced MFI by 1.7–2.5 fold. Both demonstrated similar hemolytic and thrombotic profiles. Conclusions: In this in vitro plasmapheresis model of IT and anti-HLA antibody reduction, both MP and CP incorporated into the EC circuit can be used quickly and effectively to reduce circulating antibodies. While CP may have some greater efficiency, further study is necessary to verify this in vivo. |
| first_indexed | 2024-03-07T21:37:44Z |
| format | Article |
| id | doaj.art-915ba50999cb456191773bb1fc5faa25 |
| institution | Directory Open Access Journal |
| issn | 0022-1058 2969-8960 |
| language | English |
| last_indexed | 2024-03-07T21:37:44Z |
| publishDate | 2023-12-01 |
| publisher | EDP Sciences |
| record_format | Article |
| series | The Journal of ExtraCorporeal Technology |
| spelling | doaj.art-915ba50999cb456191773bb1fc5faa252024-02-26T11:28:10ZengEDP SciencesThe Journal of ExtraCorporeal Technology0022-10582969-89602023-12-0155418919310.1051/ject/2023034ject230007An in vitro comparison of intra-operative isohemagglutinin and human leukocyte antigen removal techniques in pediatric heart transplantationHayes Emily A.0https://orcid.org/0000-0002-4569-6860Walczak Ashley B1Goodhue Meyer Erin2Nicol Kathleen3Deitemyer Matthew4https://orcid.org/0009-0005-7156-4158Duffy Vicky5Moore Padilla Michelle6Gajarski Robert J.7Nandi Deipanjan8https://orcid.org/0000-0003-0144-1433The Heart Center, Nationwide Children’s HospitalThe Heart Center, Nationwide Children’s HospitalDepartment of Hematology/Apheresis, Nationwide Children’s HospitalDepartment of Pathology, Nationwide Children’s HospitalThe Heart Center, Nationwide Children’s HospitalThe Heart Center, Nationwide Children’s HospitalDivision of Cardiology, Department of Pediatrics, Emory University School of MedicineThe Heart Center, Nationwide Children’s HospitalThe Heart Center, Nationwide Children’s HospitalBackground: Highly sensitized pediatric patients awaiting heart transplantation experience longer wait times and thus higher waitlist mortality. Similarly, children less than 2 years of age have increased waitlist times and mortality when compared to their older peers. To improve the likelihood of successful transplantation in these patients, various strategies have been utilized, including peri-operative plasmapheresis. However, limited data exists comparing plasmapheresis techniques for antibody reduction. This study’s aim was to compare the in vitro magnitude of isohemagglutinin titers (IT) and human leukocyte antigen (HLA) antibody removal and the time required between membrane-based plasmapheresis (MP) and centrifuge-based plasmapheresis (CP) incorporated into the extracorporeal (EC) circuit. Methods: Two MP (Prismaflex) and two CP (Spectra Optia, Terumo BCT) circuits were incorporated into four separate EC circuits primed with high titer, highly sensitized type O donor whole blood. Assays were performed to determine baseline IT and anti-HLA antibodies and then at 30-minute increments until completion of the run (two plasma volume exchanges) at two hours. Results: There was a decrease in anti-A and anti-B IgM and IgG titers with both MP and CP. Mean anti-A and anti-B titer reduction was by 4.625 titers (93.7% change) and 4.375 titers (93.8% change) using MP and CP, respectively. At 2 h of apheresis, CP reduced 62.5% of all ITs to ≤ 1:4, while MP reduced 50% of ITs to ≤ 1:4. Additionally, reduction of anti-HLA class II antibody to mean fluorescence intensity (MFI) <3000 was achieved with both MP and CP. At 2 h of apheresis, CP reduced MFI by 2–3.5 fold and MP reduced MFI by 1.7–2.5 fold. Both demonstrated similar hemolytic and thrombotic profiles. Conclusions: In this in vitro plasmapheresis model of IT and anti-HLA antibody reduction, both MP and CP incorporated into the EC circuit can be used quickly and effectively to reduce circulating antibodies. While CP may have some greater efficiency, further study is necessary to verify this in vivo.https://ject.edpsciences.org/articles/ject/full_html/2023/04/ject230007/ject230007.htmlisohemagglutininhuman leukocyte antigenplasmapheresispediatric heart transplantation |
| spellingShingle | Hayes Emily A. Walczak Ashley B Goodhue Meyer Erin Nicol Kathleen Deitemyer Matthew Duffy Vicky Moore Padilla Michelle Gajarski Robert J. Nandi Deipanjan An in vitro comparison of intra-operative isohemagglutinin and human leukocyte antigen removal techniques in pediatric heart transplantation The Journal of ExtraCorporeal Technology isohemagglutinin human leukocyte antigen plasmapheresis pediatric heart transplantation |
| title | An in vitro comparison of intra-operative isohemagglutinin and human leukocyte antigen removal techniques in pediatric heart transplantation |
| title_full | An in vitro comparison of intra-operative isohemagglutinin and human leukocyte antigen removal techniques in pediatric heart transplantation |
| title_fullStr | An in vitro comparison of intra-operative isohemagglutinin and human leukocyte antigen removal techniques in pediatric heart transplantation |
| title_full_unstemmed | An in vitro comparison of intra-operative isohemagglutinin and human leukocyte antigen removal techniques in pediatric heart transplantation |
| title_short | An in vitro comparison of intra-operative isohemagglutinin and human leukocyte antigen removal techniques in pediatric heart transplantation |
| title_sort | in vitro comparison of intra operative isohemagglutinin and human leukocyte antigen removal techniques in pediatric heart transplantation |
| topic | isohemagglutinin human leukocyte antigen plasmapheresis pediatric heart transplantation |
| url | https://ject.edpsciences.org/articles/ject/full_html/2023/04/ject230007/ject230007.html |
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