The safety measures for double filtration plasma apheresis (DFPP) before ABO-incompatible kidney transplantation

Nishi, Shinichi; Hasegawa, S.; Gejyo, Fumitake; Saito, Kazuhide; Nakagawa, Yuki; Takahashi, Kota

doi:10.1016/j.ics.2006.03.059

Cited by 6 publications

(4 citation statements)

References 7 publications

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“…In this study, 0.5 to 0.8 L FFP was used as the replacement fluid, leading to a serum albumin reduction of 14.05% and only 2 episodes of symptomatic hypotension observed during 44 DFPP sessions. Nishi et al reported that if using 12.5% albumin as the replacement fluid, a significant decline in globulins with a higher post-DFPP serum albumin was observed, without any hypotensive episode (11). Undoubtedly, a lower incidence of hypotension can accompany a higher albumin concentration in the replacement fluid.…”

Section: Discussionmentioning

confidence: 99%

Double filtration plasmapheresis for children with different types of critical kidney diseases: a single-center retrospective cohort study

Quan¹,

Chen²,

Yang³

et al. 2023

Transl Pediatr

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Background: Double filtration plasmapheresis (DFPP) was initially used to facilitate the conduction of ABO-incompatible renal transplantation. The applicability of DFPP has recently expanded to cover the removal of various antibodies in adults with immune-mediated diseases. However, DFPP is seldom used in children, with few reports addressing its efficacy and safety in this population. This study aimed to explore the efficacy and adverse effects of DFPP for pediatric patients with renal indications.Methods: Children who received DFPP between December 2017 and December 2020 at Tongji Hospital were retrospectively studied, and sub-grouped for analysis according to the types of disease. All children received 3 to 6 DFPP sessions within 2 to 3 weeks, and were assessed for clinical outcomes according to glomerular filtration rate, proteinuria and extra-renal symptoms. Pre-and post-DFPP plasma were collected to measure the levels of pathogenic autoantibodies, immunoglobulins, fibrinogen, albumin, calcium, etc. Inhospital complications were also recorded.Results: Totally there were 10 children receiving 44 sessions of DFPP, including 2 males and 8 females, with a median age of 11.2 years old (5-13 years) and a median weight of 42.1 kg (20-59 kg). Five patients were treated for systemic lupus erythematosus (SLE), three patients for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), one for C3 glomerulopathy and one for ABO-incompatible renal transplantation. Plasma autoantibodies decreased substantially by 93% and 89% in those with SLE and AAV after the last session, respectively. Complete or partial responses were achieved in 80%, 33.3%, 100% and 100% of patients with SLE, AAV, C3 glomerulopathy, and ABO-incompatible renal transplantation, respectively. The proportion of cumulative IgG, fibrinogen, and albumin removal at the end of the last sessions were 58.8%, 67.69%, and 14.05% respectively. The removal of calcium, potassium and creatinine were not statistically significant. A few episodes (4.55%) of hypotension were observed when fresh frozen plasma was used as the replacement fluid, and no bleeding nor severe anaphylaxis was noted. Conclusions:The efficacy and safety of DFPP treatment in children with SLE, AAV, C3 glomerulopathy and ABO-incompatible renal transplantation were described in the present study. DFPP is proven to be a safe apheresis method for children weighing more than 20 kg.

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Section: Discussionmentioning

confidence: 99%

Double filtration plasmapheresis for children with different types of critical kidney diseases: a single-center retrospective cohort study

Quan¹,

Chen²,

Yang³

et al. 2023

Transl Pediatr

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“…came up with the idea of using 12.5% albumin in which there is a significant deficiency of globulins with higher post-DFPP albumin, and there were no hypotensive episodes. [ 16 ] There is no doubt that, higher the albumin concentration, lesser will be the hypotension and as albumin is an expensive replacement solution, we hypothesized effluent albumin concentration (1.75–2.0 times the serum albumin) is a systematic way of physiologically replacing albumin in patients and may also be cost effective.…”

Section: Discussionmentioning

confidence: 99%

“…– no replacements; Tanabe – 7.5% albumin;[ 6 ] Nishi et al . 12.5%;[ 16 ] our study-effluent concentration as replacements). If cost is not a consideration, opting for the highest concentration of albumin will be beneficial, otherwise, patients financial situation, frailty, and evidence shown in various studies should be the deciding factors in choosing the replacement solution.…”

Section: Discussionmentioning

confidence: 99%

Effect of double filtration plasmapheresis on various plasma components and patient safety: A prospective observational cohort study

Jagdish¹,

Jacob²,

Varughese³

et al. 2017

Indian J Nephrol

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Double filtration plasmapheresis (DFPP) was historically used for blood group incompatible renal transplantation. Very few studies are available worldwide regarding its efficiency in removing specific plasma components, and safety. We conducted a prospective observational cohort study over 1 year on patients undergoing DFPP for various renal indications. There were 15 patients with 39 sessions. The pre- and post-procedure plasma samples of serum IgG, IgA, IgM, fibrinogen, calcium, phosphate, potassium, and magnesium were analyzed. The effluent albumin concentration was also measured, and complications during the hospital stay were recorded. Cumulative removal of serum IgG, IgA, IgM, fibrinogen, and albumin at the end of four sessions were 72%, 89%, 96%, 88.5%, and 21.3%, respectively and effluent albumin concentration was 1.75 – 2.0 times (range: 6.3 g/dl – 7.2 g/dl; mean ± standard deviation (SD) – 7 g/dl ± 0.3 g/dl) the preprocedural serum albumin (mean ± SD – 3.5 g/dl ± 0.5 g/dl). Removal of other plasma components were not statistically significant. Hypotensive episodes were observed only 16.6%, with the usage of effluent concentration albumin as replacement fluid despite an average 2.4 (mean ± SD – 2.4 ± 0.4 l) liters of plasma volume processing each session. DFPP removes IgG, IgA, IgM, fibrinogen, and albumin. The cumulative removal IgG (72%) is suboptimal, whereas IgA (89%) and IgM (96%) are comparable to historical controls. We observed lesser episodes (12.5%) of hypotension with effluent albumin concentration as replacement fluid, and all bleeding complications were observed when serum fibrinogen level was <50 mg/dl.

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“…[34][35][36][37][38][39][40][41] Concept of antibody removal before transplantation 1. Serum antibody titers should be 1 : 16 or lower before transplantation.…”

Section: Extracorporeal Immunomodulation: Serum Anti-a Anti-b Antibodmentioning

confidence: 99%

Recent findings in ABO-incompatible kidney transplantation: classification and therapeutic strategy for acute antibody-mediated rejection due to ABO-blood-group-related antigens during the critical period preceding the establishment of accommodation

Takahashi

2007

Clin Exp Nephrol

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In Japan, ABO-incompatible kidney transplantation has been performed in more than 1000 patients since 1989, and recently accounts for about 18% of all living donor kidney transplants. As for outcomes, since 2001 the 1-year and 3-year graft survival rates have increased to 96% and 94%, respectively, which are similar to those in ABO-compatible transplantation. These improved outcomes are attributed to a clearer understanding of the mechanisms underlying accommodation and acute antibody-mediated rejection, permitting the development of new therapeutic strategies. This review classifies and discusses the clinical significance of acute antibody-mediated rejection due to ABO-blood-group-related antigens during the critical period preceding the establishment of accommodation.

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The safety measures for double filtration plasma apheresis (DFPP) before ABO-incompatible kidney transplantation

Cited by 6 publications

References 7 publications

Double filtration plasmapheresis for children with different types of critical kidney diseases: a single-center retrospective cohort study

Double filtration plasmapheresis for children with different types of critical kidney diseases: a single-center retrospective cohort study

Effect of double filtration plasmapheresis on various plasma components and patient safety: A prospective observational cohort study

Recent findings in ABO-incompatible kidney transplantation: classification and therapeutic strategy for acute antibody-mediated rejection due to ABO-blood-group-related antigens during the critical period preceding the establishment of accommodation

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