Noble Johan, Metzger Antoine, Naciri Bennani Hamza, Daligault Melanie, Masson Dominique, Terrec Florian, Imerzoukene Farida, Bardy Beatrice, Fiard Gaelle, Marlu Raphael, Chevallier Eloi, Janbon Benedicte, Malvezzi Paolo, Rostaing Lionel, Jouve Thomas
Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, University Hospital Grenoble, 38000 Grenoble, France.
University Grenoble Alpes, 38000 Grenoble, France.
J Clin Med. 2021 Mar 23;10(6):1316. doi: 10.3390/jcm10061316.
Nearly 18% of patients on a waiting list for kidney transplantation (KT) are highly sensitized, which make access to KT more difficult. We assessed the efficacy and tolerance of different techniques (plasma exchanges [PE], double-filtration plasmapheresis [DFPP], and immunoadsorption [IA]) to remove donor specific antibodies (DSA) in the setting of HLA-incompatible (HLAi) KT. All patients that underwent apheresis for HLAi KT within a single center were included. Intra-session and inter-session Mean Fluorescence Intensity (MFI) decrease in DSA, clinical and biological tolerances were assessed. A total of 881 sessions were performed for 45 patients: 107 DFPP, 54 PE, 720 IA. The procedures led to HLAi KT in 39 patients (87%) after 29 (15-51) days. A higher volume of treated plasma was associated with a greater decrease of inter-session class I and II DSA ( = 0.04, = 0.02). IA, PE, and a lower maximal DSA MFI were associated with a greater decrease in intra-session class II DSA ( < 0.01). Safety was good: severe adverse events occurred in 17 sessions (1.9%), more frequently with DFPP (6.5%) < 0.01. Hypotension occurred in 154 sessions (17.5%), more frequently with DFPP ( < 0.01). Apheresis is well tolerated (IA and PE > DFPP) and effective at removing HLA antibodies and allows HLAi KT for sensitized patients.
在肾脏移植（KT）等待名单上，近18%的患者高度致敏，这使得获得KT变得更加困难。我们评估了不同技术（血浆置换[PE]、双重过滤血浆置换[DFPP]和免疫吸附[IA]）在HLA不相容（HLAi）KT情况下清除供体特异性抗体（DSA）的疗效和耐受性。纳入了在单一中心接受HLAi KT血液分离术的所有患者。评估了术中及术后DSA的平均荧光强度（MFI）下降情况、临床和生物学耐受性。共对45例患者进行了881次治疗：107次DFPP、54次PE、720次IA。29（15 - 51）天后，39例患者（87%）通过这些程序接受了HLAi KT。较高的处理血浆量与术后I类和II类DSA的更大降幅相关（= 0.04，= 0.02）。IA、PE和较低的最大DSA MFI与术中II类DSA的更大降幅相关（< 0.01）。安全性良好：17次治疗（1.9%）发生严重不良事件，DFPP更为常见（6.5%）< 0.01。154次治疗（17.5%）发生低血压，DFPP更为常见（< 0.01）。血液分离术耐受性良好（IA和PE > DFPP），能有效清除HLA抗体，并使致敏患者能够接受HLAi KT。
