Plasmapheresis, Photopheresis, and Endovenous Immunoglobulin in Acute Antibody-mediated Rejection in Kidney Transplantation

Pretagostini, R.; Poli, L.; Gozzer, Maria; Pettorini, Laura; Garofalo, M.; Novelli, Simone; Cinti, P; Berloco, P.

doi:10.1016/j.transproceed.2015.01.030

Cited by 8 publications

(4 citation statements)

References 11 publications

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“…Therefore, DFPP is implemented in some centers in preconditioning regimens for antibody-incompatible kidney transplantation (AB0i [18] and/or HLAi [19]). Earlier, in a study by Pretagostini and others [20], DFPP was compared with IA for treatment of ABMR and found comparably both effective in resolving ABMR and safe. As demonstrated in the study by Eskandary et al [17], a combination treatment of DFPP + IA appeared to be more effective in clearing IgM antibodies and complement factors, particularly C1q, compared to IA alone in a preconditioning regimen.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Double Membrane Filtration Immunoadsorption in Severe C1q-Binding Donor-Specific Antibody-Positive Acute Humoral Kidney Allograft Rejection: A Case Series

Rußwurm¹,

Maier-Giebing²,

Kortus-Goetze³

et al. 2023

Blood Purif

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Introduction: Acute antibody-mediated rejection (ABMR) is an important threat to renal allograft survival in the early transplant period and the major single cause of graft loss in the first postoperative year. Semi-selective immunoadsorption (IA) remains one of the commonly applied treatments in ABMR, reducing allo-reactive antibody load. Adding double filtration plasmapheresis (DFPP) to IA might enhance therapeutic efficacy by also addressing innate humoral effectors like complement factors. Methods: Four patients with ABMR were treated with DFPP + IA. Clinical, histological, and immunological data and adverse events were retrospectively collected. Results: Here we present four high-risk treatment-refractory ABMR cases with C1q-binding donor-specific antibodies and histology of humoral rejection under treatment with DFPP + IA. While the earlier cases (within the first year after transplantation) showed marked reduction in ABMR severity and improvement of kidney function, the later cases did not respond accordingly. Late ABMR patient 1 stabilized, whereas late ABMR patient 2 did not respond to treatment. Conclusions: Our data support the consideration of DFPP + IA as a rescue treatment option in early, severe, high-risk ABMR cases in which other treatments failed.

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Section: Discussionmentioning

confidence: 99%

Efficacy of Double Membrane Filtration Immunoadsorption in Severe C1q-Binding Donor-Specific Antibody-Positive Acute Humoral Kidney Allograft Rejection: A Case Series

Rußwurm¹,

Maier-Giebing²,

Kortus-Goetze³

et al. 2023

Blood Purif

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“…IA can faster to remove DSA than DFPP [45], and compared to plasmapheresis, IA allows not only a more specific but also a more effective clearance of circulating immunoglobulins without the side effects associated with the substitution of FFP or albumin [46,47]. However, the higher costs associated with the use of IA indicates its use in high-risk populations (i.e., hyperimmune or ABO-I patients, pretransplantcross-match positivity, AAMR) [38]. Therefore, we suggest that DFPP aimed at AMR is significantly effective, cheap, and at low risks of infection.…”

Section: Discussionmentioning

confidence: 99%

“…The combined therapy consisting of steroid pulses, IVIG, TPE and rituximab had been proved to be effective. More recently, Pretagostini et al [38] compared retrospectively 23 transplanted patients (group A) treated with protein-A IA versus 7 patients (group B) with DFPP. They had observed that the 2 extracorporeal procedures had similar effects in terms of graft survival, DSA removal, and cross-match negativity (group A 74 vs. 86%; 95 vs. 100%).…”

Section: Antibody-mediated Rejectionmentioning

confidence: 99%

Plasmapheresis Therapy in Kidney Transplant Rejection

et al. 2018

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Kidney transplantation (KT) is considered an optimal treatment strategy for end-stage renal disease. But human leukocyte antigen-sensitized, ABO-incompatible and antibody-mediated rejection might be the alarming hurdles in KT. Therapeutic plasma exchange is the mainstay of the antibody reduction therapy for reducing autoantibody more effectively. Even in the treatment for highly sensitized patients, it has played an indispensable role. However, clinicians should tailor therapies to individual patient’s needs and multimodal treatment will bring better outcomes. Early diagnosis and precise treatment would reduce morbidity, mortality, and economic costs.

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“…В большинство протоколов входят различные варианты ПА. Дальнейшим развитием методики ПА стала каскадная плазмофильтрация (КПФ) -метод селективного удаления молекул определенной молекулярной массы, участвующих в реакции отторжения (антител, компонентов системы комплемента) [14,15]. Мы провели исследование по оценке целесообразности включения данного весьма дорогостоящего метода в схему десенсибилизации реципиентов с невысоким уровнем сенсибилизации.…”

Section: терапевтический архив 8 2016unclassified