Plasmapheresis in nephrology: an update

Rahman, Tahminur; Harper, Lorraine

doi:10.1097/01.mnh.0000247503.87162.15

Cited by 21 publications

(10 citation statements)

References 71 publications

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“…In the 1980s, there was some success in the transplantation of A 2 kidneys into O recipients without TPE (34,35). The most common subgroups of blood group A are A 1 and A 2 .…”

Section: The Role Of the Abo Titer In Amr Has Historically Been Unclementioning

confidence: 99%

ABO Antibody Titer and Risk of Antibody‐Mediated Rejection in ABO‐Incompatible Renal Transplantation

Tobian¹,

Shirey²,

Montgomery

et al. 2010

American Journal of Transplantation

112

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“…In the 1980s, there was some success in the transplantation of A 2 kidneys into O recipients without TPE (34,35). The most common subgroups of blood group A are A 1 and A 2 .…”

Section: The Role Of the Abo Titer In Amr Has Historically Been Unclementioning

confidence: 99%

ABO Antibody Titer and Risk of Antibody‐Mediated Rejection in ABO‐Incompatible Renal Transplantation

Tobian¹,

Shirey²,

Montgomery

et al. 2010

American Journal of Transplantation

112

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“…Therapeutic plasma exchange (TPE) or double-filtration plasmapheresis (DFPP) non-specifically immune complexes, protein bound toxins, circulating antibodies, complement components, and coagulation factors (35, 36). In TPE, the plasma fraction of whole blood is removed by either filtration or differential centrifugation (36).…”

Section: Emerging Targets For Clinical Interventionmentioning

confidence: 99%

“…A study comparing TPE and DFPP showed that while the maximal plasma volume treated with DFPP was almost twice that of TPE and DFPP removed total IgG effectively, there was no overall advantage in reduction in DSA levels (37). In renal transplantation these modalities have also been used to for removal of isohemaggluinins (anti-ABO antibodies) in ABO incompatible transplantation, removal of donor-specific allo- antibodies in HLA sensitized patients pre-transplant and during AMR (35, 36). …”

Section: Emerging Targets For Clinical Interventionmentioning

confidence: 99%

“…A single-center, observational study showed 1-year graft survival of 86% in patients with AMR who responded to TPE and a 3 and 5 year graft survival of 86% and 78% respectively (51). Complications of TPE or TPE are related to complications of vascular access, allergic and infections reactions to transfusion products, hypotension, increased risk of hemorrhage, and hypocalcemia (35, 38). The cause of the hypocalcemia is likely two-fold: removal of plasma calcium bound to albumin and free calcium by binding to citrate.…”

Section: Emerging Targets For Clinical Interventionmentioning

confidence: 99%

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Rational clinical trial design for antibody mediated renal allograft injury

Sandal

Zand

2015

Front Biosci

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Antibody mediated renal allograft rejection is a significant cause of acute and chronic graft loss. Recent work has revealed that AMR is a complex processes, involving B and plasma cells, donor-specific antibodies, complement, vascular endothelial cells, NK cells, Fc receptors, cytokines and chemokines. These insights have led to the development of numerous new therapies, and adaptation of others originally developed for treatment of hemetologic malignancies, autoimmune and complement mediated conditions. Here we review emerging insights into the pathophysiology of AMR as well as current and emerging therapies for both acute and chronic AMR. Finally, we discuss rational clinical trial design in light of antibody and B cell immunobiology, as well as appropriate efficacy metrics to identify robust protocols and therapeutic agents.

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“…3 In the 1980s, Alexandre used a protocol to remove anti-ABO antibodies for the first time, but the outcome was still inferior to that of ABO-compatible kidney transplantation (KT). 4,5 Since 2000, with the advancement of immunosuppression and plasmapheresis, the outcome of ABO IKT has improved to a great extent and is comparable to that of ABO-compatible KT nowadays.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Clinical Outcome between High and Low Baseline Anti-ABO Antibody Titers in ABO-Incompatible Kidney Transplantation

et al. 2011

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High baseline anti-ABO antibody titer is still an important obstacle for successful ABO-incompatible kidney transplantation (ABO IKT). This study aims to investigate the clinical outcome of ABO IKT in patients with a high baseline titer in comparison with patients with a low baseline titer. Fourteen patients who received ABO IKT at our center were classified as the high-titer group (≥1:256, n = 8) or the low-titer group (≤1:128, n = 6). We used a protocol composed of rituximab, plasmapheresis, and intravenous immunoglobulin (RTX/PP/IVIG). We compared the intensity of preparation, complications, and clinical outcome between the two groups. The high-titer group required more sessions of pretransplant (10.5 ± 3.5 vs. 6.0 ± 1.3 times, p = 0.01) and posttransplant (1.6 ± 1.8 vs. 0 ± 0 times) PP/IVIG than the low-titer group did. All patients from both groups showed immediate recovery of graft function. The antibody titer and allograft function in the high-titer group were stable and did not differ significantly from those of the low-titer group up to 1 year after kidney transplantation. There was no antibody-mediated rejection in either group during follow-up, but three cases of acute cellular rejection developed in the high-titer group. The high-titer group showed two cases of opportunistic viral infection (herpes gingivitis and cytomegalovirus viremia) and one case of graft loss due to postoperative bleeding. ABO IKT can be safely performed even in patients with a high baseline anti-ABO antibody titer, but the risk for infection and bleeding should be considered before transplantation.

show abstract

Plasmapheresis in nephrology: an update

Abstract: The use of plasmapheresis requires further validation by randomized clinical trials. Recent published trials should alter practice but further studies are required.

Cited by 21 publications

References 71 publications

ABO Antibody Titer and Risk of Antibody‐Mediated Rejection in ABO‐Incompatible Renal Transplantation

ABO Antibody Titer and Risk of Antibody‐Mediated Rejection in ABO‐Incompatible Renal Transplantation

Rational clinical trial design for antibody mediated renal allograft injury

Comparison of Clinical Outcome between High and Low Baseline Anti-ABO Antibody Titers in ABO-Incompatible Kidney Transplantation

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