Efficacy and safety of tandem hemodialysis and immunoadsorption to desensitize kidney transplant candidates.

Abstract

OBJECTIVES:

We conducted a desensitization program in our center in patients undergoing kidney transplant for end-stage renal disease. These patients had a living-donor either ABO incompatible and/or human-leukocyte antigen-incompatible. The safety and efficacy of this program were evaluated.

MATERIALS AND METHODS:

A pretransplant desensitization program relies on immunosuppressants and apheresis to remove detrimental antibodies. We chose immunoadsorption as the apheresis technique, and coupled this with hemodialysis in a tandem procedure.

RESULTS:

We report on the efficacy of this new method in 120 procedures performed in 20 patients (14 ABO incompatible, 6 ABO incompatible/human leukocyte antigen-incompatible). The tandem procedure was well tolerated, and saved time compared with conducting sequential immunoadsorption and hemodialysis (6 h vs 10 h). The tandem procedure was associated with significantly decreased isoagglutinin titers and donor-specific alloantibodies (assessed by mean fluorescence intensity). Dialysance was effective (183, 102-264). The biochemical and hematologic parameters were similar to those observed after a conventional hemodialysis session, with the exception of protidemia; this might be related to some degree of albumin loss during the immunoadsoprtion procedure. The posttransplant events included 1) one ABO incompatible / human leukocyte antigenincompatible patient with vein thrombosis and ultimate kidney loss; 2) two patients with steroidsensitive cellular acute rejection; and 3) two patients with acute antibody-mediated rejection, which was successfully treated with apheresis and steroid pulses, plus rituximab in one and eculizumab in the other.

CONCLUSIONS:

We conclude that the tandem immunoadsorption-hemodialysis procedure is efficient at desensitizing patients with end-stage renal disease who are candidates for a living ABO incompatible and/or human leukocyte antigenincompatible donor-kidney transplant.

• Authors: Lionel Rostaing, Sébastien Maggioni, Corinne Hecht, Martine Hermelin, Eric Faudel, Nassim Kamar, Federico Sallusto, Nicolas Doumerc, Asma Allal
• Journal: Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation (Exp Clin Transplant) Vol. 13 Suppl 1 Pg. 165-9 (Apr 2015) ISSN: 2146-8427 [Electronic] Turkey
• PMID: 25894148 (Publication Type: Evaluation Study, Journal Article)

Chemical References

• ABO Blood-Group System
• HLA Antigens
• Immunosorbents
• Isoantibodies

Topics

• ABO Blood-Group System (immunology)
• Blood Component Removal (adverse effects, methods)
• Blood Group Incompatibility (blood, diagnosis, immunology, therapy)
• Desensitization, Immunologic (adverse effects, methods)
• Graft Rejection (immunology, prevention & control)
• Graft Survival
• HLA Antigens (immunology)
• Histocompatibility
• Histocompatibility Testing
• Humans
• Immunosorbents (adverse effects, therapeutic use)
• Isoantibodies (blood)
• Kidney Failure, Chronic (blood, diagnosis, immunology, therapy)
• Kidney Transplantation (adverse effects)
• Program Evaluation
• Renal Dialysis (adverse effects)
• Risk Factors
• Time Factors
• Treatment Outcome