Plasmapherese und Immunadsorption

Renders, Lutz; Wen, Ming; Küchle, Claudius

doi:10.1007/s11560-013-0843-z

Cited by 4 publications

(4 citation statements)

References 48 publications

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“…Fresenius ART universal ® (Fresenius medical care, Bad Homburg, Germany) immunoadsorber was used. IgG extraction was performed with the commercial Protein-A columns Immunadsorba ® (Fresenius Medical Care, Bad Homburg, Germany) with high affinity to IgG1, 2, 4, and low affinity to IgG3, IgA, and IgM [10]. Immunoadsorptive therapy was performed during five consecutive days and IVIG (Privigen ® , CSL Behring, Marburg, Germany) (0.5 g/kg BW) was administered at day five after immunoadsorption.…”

Section: Methodsmentioning

confidence: 99%

Add-on Immunoadsorption Shortly-after Optimal Medical Treatment Further Significantly and Persistently Improves Cardiac Function and Symptoms in Recent-Onset Heart Failure—A Single Center Experience

et al. 2018

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Background: Immunoadsorption and intravenous immunoglobulin (IVIG) administration may have beneficial effects in patients with dilated cardiomyopathy with end-stage heart failure. We investigated the effect of immunoadsorption with subsequent IVIG administration on cardiac function and symptoms in patients on optimal medical treatment (OMT) for heart failure (HF) with recent-onset cardiomyopathy during long-term follow-up. Methods: Thirty-five patients with recent-onset of HF symptoms received intensive guideline-recommended medical HF therapy for 5.2 months. Subsequently, all patients received a single cycle of immunoadsorption for five days followed by IVIG administration. During the 29-month follow-up period, New York Heart Association (NYHA) functional class, left ventricular ejection fraction (LVEF) and N-terminal pro brain natriuretic peptide (NT-proBNP) were evaluated. Changes in quality of life (QoL) were assessed using the Minnesota Living with HF Questionnaire. Results: Three months after immunoadsorption, NYHA functional class improved from 2.0 to 1.5 (p < 0.005) and LVEF significantly increased from 27.0% to 39.0% (p < 0.0001). Long-term follow-up of 29 months showed stable NYHA functional class and a further moderate increase in LVEF from 39.0% to 42.0% (p < 0.0001) accompanied by a significant improvement in NT-proBNP and QoL scores. Conclusion: Immunoadsorption followed by IVIG administration further enhances LVEF, HF symptoms, QoL and biomarkers in patients with recent-onset HF on OMT.

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Section: Methodsmentioning

confidence: 99%

Add-on Immunoadsorption Shortly-after Optimal Medical Treatment Further Significantly and Persistently Improves Cardiac Function and Symptoms in Recent-Onset Heart Failure—A Single Center Experience

et al. 2018

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“…Therapeutic plasma exchange (TPE) eliminates pathological circulating factors through the replacement of the subjects' plasma with donor plasma product or can be performed in exchange with human albumin or electrolyte solutions as plasmapheresis (PE). In clinical nephrology, TPE or PE is currently in use for treatment of antineutrophil cytoplasmic autoantibody‐associated rapid progressive glomerulonephritis, Goodpasture's syndrome as well as atypical and typical hemolytic‐uremic syndrome and in few cases also in Henoch‐Schönlein purpura with crescent formation . The use of TPE in the treatment of primary FSGS and recurrent FSGS in kidney transplants is largely based on case reports and case series because no randomized controlled trials are available to further evaluate the treatment's potential.…”

Section: Introductionmentioning

confidence: 99%

“…In clinical nephrology, TPE or PE is currently in use for treatment of antineutrophil cytoplasmic autoantibody-associated rapid progressive glomerulonephritis, Goodpasture's syndrome as well as atypical and typical hemolytic-uremic syndrome and in few cases also in Henoch-Sch€ onlein purpura with crescent formation. 19 The use of TPE in the treatment of primary FSGS and recurrent FSGS in kidney transplants is largely based on case reports and case series because no randomized controlled trials are available to further evaluate the treatment's potential. In recurrent FSGS in kidney transplants, 71% of patients either fulfilled the criteria for a full or at least partial remission after TPE treatment; however, the data derive from a recent systematic review and meta-analyses.…”

Section: Introductionmentioning

confidence: 99%

Removal of focal segmental glomerulosclerosis (FSGS) factor suPAR using CytoSorb

Schenk

Müller-Deile

Schmitt

et al. 2017

J of Clinical Apheresis

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Treatment of primary focal segmental glomerulosclerosis (FSGS) and its recurrence after kidney transplantation associated with rapid deterioration of kidney function remains to be challenging despite advances in immunosuppressive therapy. The presence of circulating factors has been postulated to be a pivotal player in the pathogenesis of FSGS, although suPAR and CLCF-1 have been identified as the most promising causative factors. The potential therapeutic effect of suPAR elimination in an FSGS patient using CytoSorb, a hemoadsorption device that gained attention in the cytokine elimination in septic patients, was studied. Efficiency of total plasma exchange to remove suPAR was determined. CytoSorb hemoadsorption caused a 27.33% reduction of the suPAR level in a single treatment, whereas total plasma exchange showed a suPAR level reduction of 25.12% (n = 3; 95% confidence interval, 0.2777-0.8090; P < 0.01), which may indicate therapeutic potential in the treatment of primary FSGS and its recurrence in a kidney transplant.

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“…However, 30 patients showed sustained HF with reduced ejection fraction (HFrEF), only one patient had HF with mid-range ejection fraction (HFmrEF) of 42% (from 46% at initial diagnosis) at initiation of immunoadsorption after 5.2 months on OMT. Effectiveness of immunoadsorption was monitored by the expected drop of circulating IgG (Supplementary Figure S1) [15,40]. All patients attended long-term follow-up after a median of 30.5 months (IQR: 11.9–35.9 months).…”

Section: Resultsmentioning

confidence: 99%

Use of Cardiac Biomarkers for Monitoring Improvement of Left Ventricular Function by Immunoadsorption Treatment in Dilated Cardiomyopathy

et al. 2019

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Immunoadsorption and subsequent administration of intravenous immunoglobulin (IVIG) have shown beneficial effects on cardiac function and symptoms in patients with dilated cardiomyopathy. Biomarkers play an emerging role in disease monitoring and outcome prediction of heart failure (HF) patients. We aimed to analyze cardiac biomarkers as predictor for improvement of left ventricular (LV) function after immunoadsorption treatment in dilated cardiomyopathy (DCM). Thirty-one patients with dilated cardiomyopathy on optimized HF pharmacotherapy received a single cycle of immunoadsorption for five days followed by IVIG administration. Left ventricular ejection fraction (LVEF) and heart failure biomarkers (hs troponin T, hs troponin I, NT-proBNP and sST2) were evaluated before treatment, after the last cycle of immunoadsorption and during a median follow-up of 30.5 months. We correlated HF biomarkers before immunoadsorption and acute changes of HF biomarkers by immunoadsorption with LV improvement during the long-term follow-up. LV function improved significantly after immunoadsorption from 28.0 to 42.0% during the long-term follow-up (p < 0.0001). Evaluation of biomarker levels showed a significant decrease for hs troponin I (from 9.2 to 5.5 ng/L, p < 0.05) and NT-proBNP (from 789.6 to 281.2 pg/mL, p < 0.005). Correlation of biomarker levels before immunoadsorption and LVEF at the long-term follow-up show good results for hs troponin T (r = −0.40, r2 = 0.16, p < 0.05), hs troponin I (r = −0.41, r2 = 0.17, p < 0.05) and sST2 (r = −0.46, r2 = 0.19, p < 0.05). Correlation of biomarker levels before immunoadsorption and the individual increase in LV function was significant for hs troponin T (r = −0.52, r2 = 0.27, p < 0.005) and hs troponin I (r = −0.53, r2 = 0.29, p < 0.005). To imply a tool for monitoring outcome immediately after immunoadsorption treatment, we investigated the correlation of acute changes of biomarker levels by immunoadsorption treatment and individual increase in LV function. A drop in hs troponin T (r = −0.41, r2 = 0.17, p < 0.05) and hs troponin I (r = −0.53, r2 = 0.28, p < 0.005) levels demonstrate a good correlation to improvement in LVEF during the long-term follow-up. Conclusion: Hs troponin T and I levels correlate with LV function improvement during long-term follow-up. Acute decrease of troponins by immunoadsorption treatment is paralleled by individual improvement of LVEF at the long-term follow-up. Thus, troponins could serve as a monitoring tool for the improvement of LV function after immunoadsorption treatment in dilated cardiomyopathy.

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Plasmapherese und Immunadsorption

Cited by 4 publications

References 48 publications

Add-on Immunoadsorption Shortly-after Optimal Medical Treatment Further Significantly and Persistently Improves Cardiac Function and Symptoms in Recent-Onset Heart Failure—A Single Center Experience

Add-on Immunoadsorption Shortly-after Optimal Medical Treatment Further Significantly and Persistently Improves Cardiac Function and Symptoms in Recent-Onset Heart Failure—A Single Center Experience

Removal of focal segmental glomerulosclerosis (FSGS) factor suPAR using CytoSorb

Use of Cardiac Biomarkers for Monitoring Improvement of Left Ventricular Function by Immunoadsorption Treatment in Dilated Cardiomyopathy

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