Cargando…
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...
Autores principales: | , , , , , , , , , , , , , , |
---|---|
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 |
_version_ | 1783672050973409280 |
---|---|
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. |
format | Online Article Text |
id | pubmed-8005077 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
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 |
work_keys_str_mv | AT noblejohan apheresisefficacyandtoleranceinthesettingofhlaincompatiblekidneytransplantation AT metzgerantoine apheresisefficacyandtoleranceinthesettingofhlaincompatiblekidneytransplantation AT naciribennanihamza apheresisefficacyandtoleranceinthesettingofhlaincompatiblekidneytransplantation AT daligaultmelanie apheresisefficacyandtoleranceinthesettingofhlaincompatiblekidneytransplantation AT massondominique apheresisefficacyandtoleranceinthesettingofhlaincompatiblekidneytransplantation AT terrecflorian apheresisefficacyandtoleranceinthesettingofhlaincompatiblekidneytransplantation AT imerzoukenefarida apheresisefficacyandtoleranceinthesettingofhlaincompatiblekidneytransplantation AT bardybeatrice apheresisefficacyandtoleranceinthesettingofhlaincompatiblekidneytransplantation AT fiardgaelle apheresisefficacyandtoleranceinthesettingofhlaincompatiblekidneytransplantation AT marluraphael apheresisefficacyandtoleranceinthesettingofhlaincompatiblekidneytransplantation AT chevalliereloi apheresisefficacyandtoleranceinthesettingofhlaincompatiblekidneytransplantation AT janbonbenedicte apheresisefficacyandtoleranceinthesettingofhlaincompatiblekidneytransplantation AT malvezzipaolo apheresisefficacyandtoleranceinthesettingofhlaincompatiblekidneytransplantation AT rostainglionel apheresisefficacyandtoleranceinthesettingofhlaincompatiblekidneytransplantation AT jouvethomas apheresisefficacyandtoleranceinthesettingofhlaincompatiblekidneytransplantation |