Hebibi Hadia, Weclawiak Hugo, Rostaing Lionel, Beaudreuil Séverine, Allal Asma, François Hélène, Durrbach Antoine, Kamar Nassim
Department of Nephrology, Dialysis and Organ Transplantation, CHU Rangueil; INSERM U1043, IFR-BMT, CHU Purpan Toulouse, France.
Saudi J Kidney Dis Transpl. 2015 Mar;26(2):297-301. doi: 10.4103/1319-2442.152435.
Few studies have reported the use of double-filtration plasmapheresis (DFPP) in antibody-incompatible kidney transplantation. To assess the efficiency and tolerability of DFPP, we prospectively studied four chronic hemodialysis patients from two centers undergoing antibody-incompatible kidney transplantation. DFPP was used for ABO-incompatible transplantation (n = 1), for high human leukocyte antigen (HLA) immunization levels (n = 2) or for the presence of a donor-specific antibody (DSA) against a potential living donor (n = 1). In all the patients, the DFPP program was discontinued because of the adverse effects. Low blood pressure occurred during the first hour of the session in all the patients. A significant loss of plasma proteins, clotting factors and immunoglobulins also occurred during this treatment. In addition, fistula thrombosis was diagnosed in two patients. Three patients experienced gastrointestinal symptoms. The DFPP reduced the titers of the anti-B antibodies and reduced the levels of DSA in one patient, but had no effect on anti-HLA antibodies in the remaining two patients. Our study highlights the non-tolerability and poor efficacy of DFPP prior to antibody-incompatible kidney transplantation that limit its extensive use in the desensitization protocols.
很少有研究报道双重滤过血浆置换术（DFPP）在抗体不相容肾移植中的应用。为了评估DFPP的有效性和耐受性，我们前瞻性地研究了来自两个中心的4例接受抗体不相容肾移植的慢性血液透析患者。DFPP用于ABO血型不相容移植（n = 1）、高人类白细胞抗原（HLA）免疫水平（n = 2）或存在针对潜在活体供体的供体特异性抗体（DSA）（n = 1）的情况。在所有患者中，DFPP方案均因不良反应而中断。所有患者在治疗的第一小时均出现低血压。在该治疗过程中还出现了血浆蛋白、凝血因子和免疫球蛋白的显著丢失。此外，两名患者被诊断为动静脉内瘘血栓形成。三名患者出现胃肠道症状。DFPP降低了一名患者的抗B抗体滴度并降低了DSA水平，但对其余两名患者的抗HLA抗体没有影响。我们的研究强调了DFPP在抗体不相容肾移植前的不耐受性和低效性，这限制了其在脱敏方案中的广泛应用。
