Université Grenoble Alpes, Grenoble, France.
Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation, CHU Grenoble-Alpes, Grenoble, France.
Blood Purif. 2018;46(3):239-245. doi: 10.1159/000488928. Epub 2018 Jul 4.
BACKGROUND/AIMS: Antibody-mediated rejection (AMR) is related to circulating donor-specific anti-human leukocyte antigen alloantibodies (DSAs). DSAs can be removed by apheresis, for example, double-filtration plasmapheresis (DFPP). However, DFPP removes some clotting factors (fibrinogen and factor XIII [FXIII]).
This was a prospective trial including 6 DSA-mediated AMR kidney transplant recipients. Patients received 2 cycles of 3-4 consecutive DFPP sessions followed by 1 injection of rituximab (break of 4-5 days between the 2 cycles). We monitored fibrinogen and FXIII levels before and after each session of DFPP.
Overall, fibrinogen and FXIII levels were significantly decreased after each session, and were significantly reduced between the very first and very last sessions. In addition, we established a model that predicted fibrinogen and FXIII values after each session and after 2 cycles.
We established a model in order to predict fibrinogen and FXIII depletion after DFPP sessions; it may help clinicians supplement fibrinogen and/or FXIII when appropriate.
背景/目的：抗体介导的排斥反应（AMR）与循环供体特异性抗人类白细胞抗原同种抗体（DSA）有关。DSA 可以通过血浆分离术（如双重滤过血浆置换术 [DFPP]）去除。然而，DFPP 会去除一些凝血因子（纤维蛋白原和因子 XIII [FXIII]）。
这是一项前瞻性试验，包括 6 名 DSA 介导的 AMR 肾移植受者。患者接受了 2 个周期的 3-4 次连续 DFPP 治疗，随后接受了 1 次利妥昔单抗治疗（2 个周期之间间隔 4-5 天）。我们在每次 DFPP 治疗前后监测纤维蛋白原和 FXIII 水平。
总的来说，每次治疗后纤维蛋白原和 FXIII 水平显著下降，且在首次和末次治疗之间显著降低。此外，我们建立了一个预测每次治疗和 2 个周期后纤维蛋白原和 FXIII 值的模型。
我们建立了一个模型来预测 DFPP 治疗后纤维蛋白原和 FXIII 的消耗情况；它可以帮助临床医生在适当的时候补充纤维蛋白原和/或 FXIII。
