Effect of double-filtration plasmapheresis for antibody-mediated rejection on hemostasis parameters and thrombin generation

Marlu, Raphaël; Malvezzi, Paolo; Seyve, Landry; Jouve, Thomas; Maurizi, J.; Defendi, Federica; Carron, Pierre-Louis; Christophe, M.; Gouellec, Audrey Le; Polack, Benoı̂t; Rostaing, Lionel

doi:10.1016/j.thromres.2018.04.018

Cited by 17 publications

(24 citation statements)

References 33 publications

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“…Secondly, our study focused only on the effect of the first session. Because protein recovery is highly correlated with their half-lives (as we have previously demonstrated with repeated sessions of DFPP) 16 it is expected that several consecutive sessions would have further reduced the level of factors with long halve-lives, especially FXIII (~10 days) and fibrinogen (~5 days).…”

Section: Discussionmentioning

confidence: 75%

“…14,15 Recently, we have shown that DFPP significantly removes high-molecular-weight proteins from the hemostatic system and decreases levels of protein S (PS) and tissue factor pathway inhibitor (TFPI). 16 In the present study, the aim was to assess whether IA, with or without MF, alters the loss of high-molecular-weight proteins from the hemostatic system.…”

Section: Introductionmentioning

confidence: 99%

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Effect of immunoadsorption alone or combined with membrane filtration on hemostasis parameters

Marlu

Bennani

Seyve

et al. 2020

J of Clinical Apheresis

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Introduction ABO‐ or HLA‐incompatible kidney transplantation is possible thanks to pretransplant antibody‐depletion achieved by extracorporeal‐treatment modalities. These methods induce depletion of some plasma proteins and may also impact on proteins involved in hemostasis. Methods To determine the impact of one session of immunoadsorption (IA) alone or combined with membrane filtration (MF) on clotting factors and natural anticoagulants, we performed a prospective, observational study on 13 patients waiting for HLA‐/ABO‐incompatible kidney transplants. Plasma hemostasis parameters were measured before and immediately after a first session of IA alone in six patients and of IA + MF in seven patients. Results IA alone induced depletion of fibrinogen and factor XIII (FXIII) whereas IA + MF caused greater depletion of all high‐molecular‐weight hemostatic proteins (fibrinogen, FV, FVIII, FXI, FXIII, von‐Willebrand factor [VWF]). After an IA session, median reductions were 30% for fibrinogen and 43% for FXIII compared to baseline values. After a session of IA + MF, median decreases were 70% for fibrinogen, 54% for FV, 56% for FVIII, 37% for FXI, 78% for FXIII, and 62% for VWF. Noticeably, levels of low‐molecular‐weight factors (<100 kDa) were far less decreased than high‐molecular‐weight proteins with IA + MF, except for protein S and the tissue factor pathway inhibitor, which are known to be partially physiologically bound to high‐molecular‐weight molecules. Conclusions IA and IA + MF induced significant depletion of some proteins implicated in the hemostatic process; however, IA + MF resulted in stronger modifications to hemostasis parameters than IA alone. This may have potential clinical implications regarding bleeding risk, and particularly depletion of fibrinogen and FXIII.

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Section: Discussionmentioning

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Effect of immunoadsorption alone or combined with membrane filtration on hemostasis parameters

Marlu

Bennani

Seyve

et al. 2020

J of Clinical Apheresis

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“…DFPP is a blood purification method that removes pathogenic substances by 2 plasma separators with different pore sizes [1]. Since DFPP can save a large amount of exogenous plasma and reduce the occurrence of bloodborne infectious diseases, it has been widely used in severe diseases.…”

Section: Discussionmentioning

confidence: 99%

“…Double-filtration plasmapheresis (DFPP) is a semi-selective blood purification method based on dual filtration system [1]. It includes 2 parts of filters and can clear immunoglobulin, lipoprotein, and other macromolecular substances from the blood for kinds of diseases by using specific filters [2].…”

Section: Introductionmentioning

confidence: 99%

Anticoagulation Effect and Safety Observation of Regional Citrate Anticoagulation for Double-Filtration Plasmapheresis in Critical Patients

et al. 2020

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Introduction: Double-filtration plasmapheresis (DFPP) is a semi-selective blood purification method based on dual filtration system. Regional citrate anticoagulation (RCA) is an appealing anticoagulation alternative in DFPP. However, there are still few reports on the safety of RCA in DFPP treatment. Objective: To investigate the anticoagulation effect and safety of RCA for DFPP in critical patients. Methods: A total of 34 critical patients treated with DFPP were retrospectively studied. The incidence of coagulation during extracorporeal circulation after single treatment was compared before and after treatment. Heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, blood routine indexes, blood gas analysis, peripheral ionic calcium (iCa), total peripheral calcium (TCa), TCa/iCa, and complications before and after single treatment were compared. The changes of transmembrane pressure, pressure drop were measured, and the indexes of coagulation before and after treatment were compared. Results: The blood coagulation 0.05). Level of TCa was significantly decreased at 5 min after treatment (p < 0.05), but there was no statistically significant difference at 6 and 24 h (p > 0.05). No treatment-related serious complications were observed in any of the patients. Conclusions: For critical patients who underwent DFPP procedure, RCA is safety and had significant anticoagulation effects, which is worthy of clinical application.

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“…The presence of anti‐HLA antibodies is monitored beginning early postoperatively, and intravenous immunoglobulin (IVIG) is administered if preformed DSAs remain or de novo DSAs are detected . If severe AMR (such as seventh‐day syndrome) is suspected, liver biopsy, additional treatment with rituximab, plasma exchange, or double filtration plasmapheresis, and prompt retransplantation should be considered . Antibody‐mediated rejection‐induced ACR can be inhibited by treatment with basiliximab or antithymocyte globulin, which is considered in the presence of very high titers of DSAs.…”

Section: Discussionmentioning

confidence: 99%

Preformed donor‐specific antibodies are associated with 90‐day mortality in living‐donor liver transplantation

Tamura

Tohyama

Watanabe

et al. 2019

Hepatology Research

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Aim The impact of donor‐specific anti‐human leukocyte antigen (HLA) antibodies (DSAs) on living donor liver transplantation (LDLT) is unclear. The aim of this study was to investigate the association between DSAs and short‐term outcomes in LDLT recipients, and to clarify the clinical impact of DSAs. Method Anti‐HLA antibodies were screened in preoperative serum samples taken from 40 liver transplant recipients at Ehime University (Toon, Japan) between August 2001 and July 2015. Screening was carried out using the Flow‐PRA method, and DSAs were detected in anti‐HLA antibody‐positive recipients using the Luminex single‐antigen identification test. A mean fluorescence intensity of 1000 was used as the cut‐off for positivity. We retrospectively reviewed the clinical courses of patients who were DSA‐positive to elucidate early clinical manifestations in LDLT recipients. Results Fifteen (12 female and 3 male) patients (38%) had anti‐HLA antibodies. Eight of the 15 anti‐HLA antibody‐positive patients were positive for DSAs, and all were women. The 90‐day survival rate of DSA‐positive patients (50%) was significantly lower than that of DSA‐negative patients (84.4%) (0.0112; Wilcoxon test). On univariate analysis, the DSA‐positive rate was significantly higher in the 90‐day mortality group. Postoperatively, the incidence of acute cellular rejection was higher in DSA‐positive than DSA‐negative patients. Thrombotic microangiopathy developed only in DSA‐positive patients. We found no relationship between DSA status and bile duct stricture. Conclusion Preformed DSAs could be associated with elevated 90‐day mortality in LDLT recipients. Further large‐scale studies are required to verify the risk associated with DSAs in LDLT.

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Effect of double-filtration plasmapheresis for antibody-mediated rejection on hemostasis parameters and thrombin generation

Cited by 17 publications

References 33 publications

Effect of immunoadsorption alone or combined with membrane filtration on hemostasis parameters

Effect of immunoadsorption alone or combined with membrane filtration on hemostasis parameters

Anticoagulation Effect and Safety Observation of Regional Citrate Anticoagulation for Double-Filtration Plasmapheresis in Critical Patients

Preformed donor‐specific antibodies are associated with 90‐day mortality in living‐donor liver transplantation

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