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Apheresis Efficacy and Tolerance in the Setting of HLA-Incompatible Kidney Transplantation

Nearly 18% of patients on a waiting list for kidney transplantation (KT) are highly sensitized, which make access to KT more difficult. We assessed the efficacy and tolerance of different techniques (plasma exchanges [PE], double-filtration plasmapheresis [DFPP], and immunoadsorption [IA]) to remove...

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Autores principales: Noble, Johan, Metzger, Antoine, Naciri Bennani, Hamza, Daligault, Melanie, Masson, Dominique, Terrec, Florian, Imerzoukene, Farida, Bardy, Beatrice, Fiard, Gaelle, Marlu, Raphael, Chevallier, Eloi, Janbon, Benedicte, Malvezzi, Paolo, Rostaing, Lionel, Jouve, Thomas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8005077/
https://www.ncbi.nlm.nih.gov/pubmed/33806743
http://dx.doi.org/10.3390/jcm10061316
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author Noble, Johan
Metzger, Antoine
Naciri Bennani, Hamza
Daligault, Melanie
Masson, Dominique
Terrec, Florian
Imerzoukene, Farida
Bardy, Beatrice
Fiard, Gaelle
Marlu, Raphael
Chevallier, Eloi
Janbon, Benedicte
Malvezzi, Paolo
Rostaing, Lionel
Jouve, Thomas
author_facet Noble, Johan
Metzger, Antoine
Naciri Bennani, Hamza
Daligault, Melanie
Masson, Dominique
Terrec, Florian
Imerzoukene, Farida
Bardy, Beatrice
Fiard, Gaelle
Marlu, Raphael
Chevallier, Eloi
Janbon, Benedicte
Malvezzi, Paolo
Rostaing, Lionel
Jouve, Thomas
author_sort Noble, Johan
collection PubMed
description Nearly 18% of patients on a waiting list for kidney transplantation (KT) are highly sensitized, which make access to KT more difficult. We assessed the efficacy and tolerance of different techniques (plasma exchanges [PE], double-filtration plasmapheresis [DFPP], and immunoadsorption [IA]) to remove donor specific antibodies (DSA) in the setting of HLA-incompatible (HLAi) KT. All patients that underwent apheresis for HLAi KT within a single center were included. Intra-session and inter-session Mean Fluorescence Intensity (MFI) decrease in DSA, clinical and biological tolerances were assessed. A total of 881 sessions were performed for 45 patients: 107 DFPP, 54 PE, 720 IA. The procedures led to HLAi KT in 39 patients (87%) after 29 (15–51) days. A higher volume of treated plasma was associated with a greater decrease of inter-session class I and II DSA (p = 0.04, p = 0.02). IA, PE, and a lower maximal DSA MFI were associated with a greater decrease in intra-session class II DSA (p < 0.01). Safety was good: severe adverse events occurred in 17 sessions (1.9%), more frequently with DFPP (6.5%) p < 0.01. Hypotension occurred in 154 sessions (17.5%), more frequently with DFPP (p < 0.01). Apheresis is well tolerated (IA and PE > DFPP) and effective at removing HLA antibodies and allows HLAi KT for sensitized patients.
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spelling pubmed-80050772021-03-29 Apheresis Efficacy and Tolerance in the Setting of HLA-Incompatible Kidney Transplantation Noble, Johan Metzger, Antoine Naciri Bennani, Hamza Daligault, Melanie Masson, Dominique Terrec, Florian Imerzoukene, Farida Bardy, Beatrice Fiard, Gaelle Marlu, Raphael Chevallier, Eloi Janbon, Benedicte Malvezzi, Paolo Rostaing, Lionel Jouve, Thomas J Clin Med Article Nearly 18% of patients on a waiting list for kidney transplantation (KT) are highly sensitized, which make access to KT more difficult. We assessed the efficacy and tolerance of different techniques (plasma exchanges [PE], double-filtration plasmapheresis [DFPP], and immunoadsorption [IA]) to remove donor specific antibodies (DSA) in the setting of HLA-incompatible (HLAi) KT. All patients that underwent apheresis for HLAi KT within a single center were included. Intra-session and inter-session Mean Fluorescence Intensity (MFI) decrease in DSA, clinical and biological tolerances were assessed. A total of 881 sessions were performed for 45 patients: 107 DFPP, 54 PE, 720 IA. The procedures led to HLAi KT in 39 patients (87%) after 29 (15–51) days. A higher volume of treated plasma was associated with a greater decrease of inter-session class I and II DSA (p = 0.04, p = 0.02). IA, PE, and a lower maximal DSA MFI were associated with a greater decrease in intra-session class II DSA (p < 0.01). Safety was good: severe adverse events occurred in 17 sessions (1.9%), more frequently with DFPP (6.5%) p < 0.01. Hypotension occurred in 154 sessions (17.5%), more frequently with DFPP (p < 0.01). Apheresis is well tolerated (IA and PE > DFPP) and effective at removing HLA antibodies and allows HLAi KT for sensitized patients. MDPI 2021-03-23 /pmc/articles/PMC8005077/ /pubmed/33806743 http://dx.doi.org/10.3390/jcm10061316 Text en © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Noble, Johan
Metzger, Antoine
Naciri Bennani, Hamza
Daligault, Melanie
Masson, Dominique
Terrec, Florian
Imerzoukene, Farida
Bardy, Beatrice
Fiard, Gaelle
Marlu, Raphael
Chevallier, Eloi
Janbon, Benedicte
Malvezzi, Paolo
Rostaing, Lionel
Jouve, Thomas
Apheresis Efficacy and Tolerance in the Setting of HLA-Incompatible Kidney Transplantation
title Apheresis Efficacy and Tolerance in the Setting of HLA-Incompatible Kidney Transplantation
title_full Apheresis Efficacy and Tolerance in the Setting of HLA-Incompatible Kidney Transplantation
title_fullStr Apheresis Efficacy and Tolerance in the Setting of HLA-Incompatible Kidney Transplantation
title_full_unstemmed Apheresis Efficacy and Tolerance in the Setting of HLA-Incompatible Kidney Transplantation
title_short Apheresis Efficacy and Tolerance in the Setting of HLA-Incompatible Kidney Transplantation
title_sort apheresis efficacy and tolerance in the setting of hla-incompatible kidney transplantation
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8005077/
https://www.ncbi.nlm.nih.gov/pubmed/33806743
http://dx.doi.org/10.3390/jcm10061316
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