Rostaing Lionel, Maggioni Sébastien, Hecht Corinne, Hermelin Martine, Faudel Eric, Kamar Nassim, Sallusto Federico, Doumerc Nicolas, Allal Asma
From the Department of Nephrology and Organ Transplantation, University Hospital Toulouse, France; the Department of Urology, Transplantation, and Andrology; and the INSERM U563, IFR-BMT, CHU Purpan, Toulouse, France.
Exp Clin Transplant. 2015 Apr;13 Suppl 1:165-9.
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.
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.
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.
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.
我们在本中心对终末期肾病接受肾移植的患者开展了一项脱敏计划。这些患者的活体供者存在ABO血型不相容和/或人类白细胞抗原不相容的情况。对该计划的安全性和有效性进行了评估。
移植前脱敏计划依赖免疫抑制剂和血液分离术来清除有害抗体。我们选择免疫吸附作为血液分离技术，并将其与串联进行的血液透析相结合。
我们报告了该新方法在20例患者中进行的120次操作的有效性（14例ABO血型不相容，6例ABO血型不相容/人类白细胞抗原不相容）。串联操作耐受性良好，与依次进行免疫吸附和血液透析相比节省了时间（6小时对10小时）。串联操作与异凝集素滴度和供者特异性同种抗体显著降低相关（通过平均荧光强度评估）。透析效率良好（183, 102 - 264）。生化和血液学参数与常规血液透析 session 后观察到的参数相似，但蛋白血症除外；这可能在一定程度上与免疫吸附过程中白蛋白的丢失有关。移植后事件包括：1）1例ABO血型不相容/人类白细胞抗原不相容患者发生静脉血栓形成并最终失去肾脏；2）2例患者发生类固醇敏感型细胞急性排斥反应；3）2例患者发生急性抗体介导的排斥反应，通过血液分离术和类固醇冲击成功治疗，其中1例加用利妥昔单抗，另1例加用依库珠单抗。
我们得出结论，免疫吸附 - 血液透析串联操作对于使终末期肾病且有活体ABO血型不相容和/或人类白细胞抗原不相容供肾移植候选资格的患者脱敏是有效的。
