Comparing the efficacy of three techniques to reduce isoagglutinin titers in AB0 incompatible kidney transplant recipients

Parmentier, Simon; Rosenkranz, Eliot R.; Schirutschke, Holger; Opgenoorth, Mirian; Quick, Cedric A.; Hoelig, Kristina; Rosner, Andrea; Hohenstein, Bernd; Hugo, Christian; Passauer, Jens

doi:10.1016/j.atherosclerosissup.2017.05.017

Cited by 6 publications

(8 citation statements)

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“…However, both adsorbers also bind with a lower affinity IgM and IgA. The relevance of IgA and IgM for the progression of immune‐mediated diseases and of their removal on the clinical effectiveness of immunoadsorption is not uniform across different indications, and is only occasionally addressed [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Performance, clinical effectiveness, and safety of immunoadsorption in a wide range of indications

et al. 2021

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Immunoadsorption is well known to selectively remove immunoglobulins and immune complexes from plasma and is applied in a variety of autoimmune diseases and for desensitization before, or at acute rejection after organ transplantation. Performance, safety, and clinical effectiveness of immunoadsorption were the aim of this study. This prospective, noninterventional, multicentre cohort study included patients treated with immunoadsorption (Immunosorba or GLOBAFFIN adsorbers) for any indication. Clinical effectiveness was assessed after termination of the patient's individual treatment schedule. Eighty‐one patients were included, 69 were treated with Immunosorba, 11 with GLOBAFFIN, one patient with both adsorbers. A majority of patients was treated for neurological indications, dilated cardiomyopathy, and before or after kidney or heart transplantation. Mean IgG reduction from pre‐ to post‐treatment was 69.9% ± 11.5% for Immunosorba and 74.1% ± 5.0% for GLOBAFFIN, respectively. The overall IgG reduction over a complete treatment block was 68%–93% with Immunosorba and 62%–90% with GLOBAFFIN depending on the duration of the overall treatment. After termination of the immunoadsorption therapy, an improvement of clinical status was observed in 63.0%, stabilization of symptoms in 29.6%, and a deterioration in 4.9% of patients. Changes in fibrinogen, thrombocytes, and albumin were mostly classified as noncritical. Overall, the treatments were well tolerated. Immunoadsorption in routine clinical practice with both GLOBAFFIN and Immunosorba has been safely performed, was well tolerated by patients, and effective in lowering immunoglobulins with an improvement or maintenance of clinical status, thus represents an additional therapeutic option for therapy refractory immune disorders.

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Section: Discussionmentioning

confidence: 99%

Performance, clinical effectiveness, and safety of immunoadsorption in a wide range of indications

et al. 2021

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“…A combination of IA and membrane filtration effectively removed IgM-type and even enhanced net IgG-type isoagglutinin elimination compared with IA alone. 17 Our study is a major contribution to this field in that it provides the last piece of the desensitization apheresis puzzle: we compared double-filtration plasmapheresis to plasmapheresis either using centrifugation or filtration in 29 ABOi kidney-transplant candidates. The three groups were comparable according to baseline demographics, and the treated plasma volumes were similar across the three groups, that is, 4111 ± 403 mL (cTP), 3861 ± 282 mL (fTP), and 3699 ± 820 mL (DFPP), that is, around 53 mL/kg.…”

Section: Discussionmentioning

confidence: 99%

“…Parmentier et al performed a retrospective analysis of 22 ABOi kidney‐transplant candidates in which they compared how efficiently IgG‐ and IgM isoagglutinins were reduced by either semispecific immunoadsorption (Globaffin columns), IA combined with membrane filtration (MONET), or by centrifugation TP 17 . The median pre‐treatment IgG isoagglutinin titers were 32 (4‐4096) whereas IgM titers were 16 (1‐256), respectively.…”

Section: Discussionmentioning

confidence: 99%

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Isoagglutinin removal by plasma centrifugation or filtration (single or double): A prospective study in a single center

Bennani

Noble

Chevallier

et al. 2020

J of Clinical Apheresis

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Introduction: ABO-incompatible (ABOi) kidney transplantation, a wellestablished procedure, has good long-term results provided pretransplant desensitization that includes immunosuppression and apheresis. Objective: To compare, within the first pretransplant apheresis session given to 29 ABOi kidney-transplant candidates, the effect on isoagglutinin titers (both IgG and IgM isotypes) of three modalities: centrifugation therapeutic plasmapheresis (cTP; n = 10), filtration TP (fTP; n = 9), and double-filtration plasmapheresis (DFPP; n = 10). Results: The three groups were comparable according to baseline demographics. Treated plasma volumes were similar across the three groups, that is, 4111 ± 403 mL (cTP), 3861 ± 282 mL (fTP), and 3699 ± 820 mL (DFPP): that is, 54 ± 7, 53 ± 7, and 53 ± 10 mL/kg respectively. One session of centrifugation or filtration TP reduced IgG anti-A/anti-B isoagglutinin titer by~4, whereas one DFPP session reduced it by~2. One session of cTP reduced IgM anti-A isoagglutinin titer by a little less than 4, whereas fTP and DFPP sessions reduced it by~3. There were no statistical differences across the three groups regarding isoagglutinin rebound (IgG and IgM). However, isoagglutinin IgG rebound was >4 dilutions for anti-B titers compared with~2 dilutions for anti-A titers. The median decreases in IgG level were −3.9 g/L (DFPP), −5.9 g/L (cTP), and − 6.06 g/L (fTP) (p = ns). Median fibrinogen depletions were~60% (fTP), 64% (DFPP), and 76% (cTP). Conclusions: Isoagglutinin depletions within the first apheresis session were similar across cTP, fTP, and DFPP: this was numerically lower for DFPP.

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“…A similar comparison between IA and cTPE has also been attempted to assess the AT reductions in ABOi renal transplant by Parmentier et al [11]. They concluded that though cTPE showed good AT reduction efficacy, to prevent complications arising due to cTPE, the combined use of IA with a membrane filter represents a possible and effective way.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Immunoadsorption and Conventional Plasma Exchange in ABO-incompatible Renal Transplant: An Exculpatory Evidence

Agrawal¹,

Chowdhry²,

Makroo³

et al. 2019

Cureus

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Aim The objective of this study was to compare the efficacy of immunoadsorption (IA) with conventional therapeutic plasma-exchange (cTPE) in ABO-incompatible (ABOi) renal transplant. Methods Data of patients from July 2015 to June 2017 (category-I, number of patients (N) = 11; IA±cTPE) on the average length of stay (ALOS), number of cTPE/IA, antibody-titers (AT), creatinine, patient and graft survival at one year were compared retrospectively with patients in period from February 2012 to June 2015 (category-II, N = 29; cTPE only). AT of patients not decreasing to less than one fold after two cTPE were shifted for IA. For patients undergoing IA, real-time AT was done and IA stopped after target titer (TT <1:8) was achieved. Post-transplant cTPE was done if, titers rebounded to ≥1:8. Intravenous immunoglobulin (IVIG) was given after every cTPE/IA. Cost comparisons were made. Results In category-I, seven patients (63.63%) were shifted to IA from cTPE. The mean cTPE procedures in category I and II are 3.5 ± 2.4 and 4.8 ± 2.5, respectively ( p = 0.206). The mean IA procedures in category-I are 1.6 ± 0.5. The number of patients requiring post-operative TPE was less in category-I than category-II, i.e., N = 5, 45.5% vs N = 20, 69%, respectively ( p = 0.171). The expense of IA in category-I vs cTPE in category-II was statistically not significant ( p = 0.422) but had significant lesser ALOS ( p = 0.044). Expenses, when a patient undergoes both cTPE and IA (category-I), are significantly higher to category-II ( p = 0.003). The two groups were comparable in AT, creatinine value, graft and patient survival rates at one year. Conclusion Contrary to the general judgment of IA being expensive than cTPE, this study shows equivalent expenditures with comparable therapeutic outcomes.

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Comparing the efficacy of three techniques to reduce isoagglutinin titers in AB0 incompatible kidney transplant recipients

Cited by 6 publications

References 4 publications

Performance, clinical effectiveness, and safety of immunoadsorption in a wide range of indications

Performance, clinical effectiveness, and safety of immunoadsorption in a wide range of indications

Isoagglutinin removal by plasma centrifugation or filtration (single or double): A prospective study in a single center

Therapeutic Immunoadsorption and Conventional Plasma Exchange in ABO-incompatible Renal Transplant: An Exculpatory Evidence

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