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Immunoadsorption-Based HLA Desensitization in Patients Awaiting Deceased Donor Kidney Transplantation: An Interventional, Non-Randomised, Single Cohort Study

Whether immunoadsorption (IADS) as part of desensitization protocols could facilitate deceased donor kidney transplantation (KT) in highly sensitized (HS) patients remains to be proven. We retrospectively analyzed our IADS based desensitization protocol for deceased donor KTs between 2013 and 2018....

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Autores principales: Bureau, Côme, Rafat, Cédric, Taupin, Jean Luc, Malard, Stéphanie, Mesnard, Laurent, François, Hélène, Petit-Hoang, Camille, Ouali, Nacera, Hertig, Alexandre, Jamme, Matthieu, Buob, David, Rondeau, Eric, Galichon, Pierre, Luque, Yosu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10481532/
https://www.ncbi.nlm.nih.gov/pubmed/37680645
http://dx.doi.org/10.3389/ti.2023.11212
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author Bureau, Côme
Rafat, Cédric
Taupin, Jean Luc
Malard, Stéphanie
Mesnard, Laurent
François, Hélène
Petit-Hoang, Camille
Ouali, Nacera
Hertig, Alexandre
Jamme, Matthieu
Buob, David
Rondeau, Eric
Galichon, Pierre
Luque, Yosu
author_facet Bureau, Côme
Rafat, Cédric
Taupin, Jean Luc
Malard, Stéphanie
Mesnard, Laurent
François, Hélène
Petit-Hoang, Camille
Ouali, Nacera
Hertig, Alexandre
Jamme, Matthieu
Buob, David
Rondeau, Eric
Galichon, Pierre
Luque, Yosu
author_sort Bureau, Côme
collection PubMed
description Whether immunoadsorption (IADS) as part of desensitization protocols could facilitate deceased donor kidney transplantation (KT) in highly sensitized (HS) patients remains to be proven. We retrospectively analyzed our IADS based desensitization protocol for deceased donor KTs between 2013 and 2018. Fifteen HS patients (age 52 years [40–56]) were included. Waiting time before IADS was 6 years [5–10] and the interval between IADS initiation and KT was 5 months [1–12] for the 14 transplanted patients. Nine patients had prior KT. Calculated panel reactive antibody decreased significantly during the protocol (99.3% [92.5–99.9] vs. 79.4% [56.7–81.9]; p = 0.004). Death-censored graft survival was 85.7% at 1 and 2 years post-transplantation. One-year median plasma creatinine level was 135 µmol/L [111–202]. Six developed active antibody mediated rejection (ABMR) at 1 year, with a median delay of 13 days [11–26]. Eight patients developed severe infections, including two fatal outcomes. Finally, compared to 93% of patients who received desensitization receiving a KT, only 43% of a control with similar characteristics underwent transplantation. However, no difference was found in overall probability of being alive with a functioning graft at the end of follow-up. The results indicate that our IADS-based desensitization strategy was not effective due to a high rate of ABMR and severe infectious complications which pose a challenge to its universalization.
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spelling pubmed-104815322023-09-07 Immunoadsorption-Based HLA Desensitization in Patients Awaiting Deceased Donor Kidney Transplantation: An Interventional, Non-Randomised, Single Cohort Study Bureau, Côme Rafat, Cédric Taupin, Jean Luc Malard, Stéphanie Mesnard, Laurent François, Hélène Petit-Hoang, Camille Ouali, Nacera Hertig, Alexandre Jamme, Matthieu Buob, David Rondeau, Eric Galichon, Pierre Luque, Yosu Transpl Int Health Archive Whether immunoadsorption (IADS) as part of desensitization protocols could facilitate deceased donor kidney transplantation (KT) in highly sensitized (HS) patients remains to be proven. We retrospectively analyzed our IADS based desensitization protocol for deceased donor KTs between 2013 and 2018. Fifteen HS patients (age 52 years [40–56]) were included. Waiting time before IADS was 6 years [5–10] and the interval between IADS initiation and KT was 5 months [1–12] for the 14 transplanted patients. Nine patients had prior KT. Calculated panel reactive antibody decreased significantly during the protocol (99.3% [92.5–99.9] vs. 79.4% [56.7–81.9]; p = 0.004). Death-censored graft survival was 85.7% at 1 and 2 years post-transplantation. One-year median plasma creatinine level was 135 µmol/L [111–202]. Six developed active antibody mediated rejection (ABMR) at 1 year, with a median delay of 13 days [11–26]. Eight patients developed severe infections, including two fatal outcomes. Finally, compared to 93% of patients who received desensitization receiving a KT, only 43% of a control with similar characteristics underwent transplantation. However, no difference was found in overall probability of being alive with a functioning graft at the end of follow-up. The results indicate that our IADS-based desensitization strategy was not effective due to a high rate of ABMR and severe infectious complications which pose a challenge to its universalization. Frontiers Media S.A. 2023-08-23 /pmc/articles/PMC10481532/ /pubmed/37680645 http://dx.doi.org/10.3389/ti.2023.11212 Text en Copyright © 2023 Bureau, Rafat, Taupin, Malard, Mesnard, François, Petit-Hoang, Ouali, Hertig, Jamme, Buob, Rondeau, Galichon and Luque. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Health Archive
Bureau, Côme
Rafat, Cédric
Taupin, Jean Luc
Malard, Stéphanie
Mesnard, Laurent
François, Hélène
Petit-Hoang, Camille
Ouali, Nacera
Hertig, Alexandre
Jamme, Matthieu
Buob, David
Rondeau, Eric
Galichon, Pierre
Luque, Yosu
Immunoadsorption-Based HLA Desensitization in Patients Awaiting Deceased Donor Kidney Transplantation: An Interventional, Non-Randomised, Single Cohort Study
title Immunoadsorption-Based HLA Desensitization in Patients Awaiting Deceased Donor Kidney Transplantation: An Interventional, Non-Randomised, Single Cohort Study
title_full Immunoadsorption-Based HLA Desensitization in Patients Awaiting Deceased Donor Kidney Transplantation: An Interventional, Non-Randomised, Single Cohort Study
title_fullStr Immunoadsorption-Based HLA Desensitization in Patients Awaiting Deceased Donor Kidney Transplantation: An Interventional, Non-Randomised, Single Cohort Study
title_full_unstemmed Immunoadsorption-Based HLA Desensitization in Patients Awaiting Deceased Donor Kidney Transplantation: An Interventional, Non-Randomised, Single Cohort Study
title_short Immunoadsorption-Based HLA Desensitization in Patients Awaiting Deceased Donor Kidney Transplantation: An Interventional, Non-Randomised, Single Cohort Study
title_sort immunoadsorption-based hla desensitization in patients awaiting deceased donor kidney transplantation: an interventional, non-randomised, single cohort study
topic Health Archive
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10481532/
https://www.ncbi.nlm.nih.gov/pubmed/37680645
http://dx.doi.org/10.3389/ti.2023.11212
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