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J Nephropathol. 2016;5(3): 90-97.
doi: 10.15171/jnp.2016.17
PMID: 27540536
PMCID: PMC4961822
Scopus ID: 84979074036
  Abstract View: 5157
  PDF Download: 2061

Original Article

Treatment of large plasma volumes using specific immunoadsorption to desensitize ABO-incompatible kidney-transplant candidates

Lionel Rostaing 1,2,3*, Asma Allal 1, Arnaud del Bello 1, Federico Sallusto 4, Laure Esposito 1, Nicolas Doumerc 4, Bénédicte Debiol 5, Audrey Delas 6, Xavier Game 3,4, Nassim Kamar 1,3,7

1 Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France
2 INSERM U563, IFR–BMT, CHU Purpan, Toulouse, France
3 Université Toulouse III Paul Sabatier, Toulouse, France
4 Department of Urology, Andrology, and Transplantation, CHU Rangueil, Toulouse, France
5 Etablissement Français du Sang de Midi-Pyrénées, CHU Purpan, Toulouse, France
6 Laboratory of Histopathology, CHU Rangueil, Toulouse, France
7 INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France
*Corresponding Author: *Corresponding author: Professor Lionel Rostaing, Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France, Email: lrostaing@chu-grenoble.fr

Abstract

Background: ABO-incompatible (ABOi) kidney-transplantation has very good long-term results, i.e. similar to those observed for living-kidney ABO-compatible transplantation. This is because patients are desensitized at pretransplant using apheresis and rituximab therapy, with tacrolimus-based immunosuppression. 

Objectives: To assess the efficacy of a single, pretransplant (Day –1), specific immunoadsorption session using Glycosorb® columns (anti-A or anti-B; Glycorex Sweden) to treat large volumes of plasma (up to 18 L). 

Patients and Methods: Prospective single-center study evaluating 12 consecutive patients (6 males), aged 40 (23–59) years. Incompatibilities were A into 0 (8), B into 0 (3), and AB into 0 (1). Pretransplant desensitization relied on rituximab (D–30), tacrolimus, mycophenolic acid, and steroids (all started on D–13), and a single session of specific immunoadsorption on D–1. Immunoadsorption was coupled in tandem with a hemodialysis session. Results: Overall, 15 L (11–18) of plasma were treated per patient, i.e., 0.2 (0.11–0.36 L/kg). Isoagglutinin titers were 1/16 (1/5–1/64) before the procedure, decreasing after 6 hours to 1/5 (1/1–1/16  P = 0.008), and to 1/2 (1/1–1/8; P = 0.05) at completion of the session. The next day, i.e., the day of transplantation, there was no rebound of isoagglutinins [1/4 (1/1–1/5); P = ns]. The procedure was well tolerated with no side-effects and no significant changes in hemoglobin level, platelet counts, fibrinogen, or albumin levels.

Conclusions: For ABOi kidney-transplantation, a single, longer, specific immunoadsorption session was very efficient at 1-day pre-transplantation with no rebound. These results should be confirmed when isoagglutinin titers are higher (≥120).


Implication for health policy/practice/research/medical education:

More and more end-stage renal disease-patients require a kidney transplant; due to a lack of deceased donor, living-kidneytransplantation is a good option. However, sometimes we face ABO incompatibility (ABOi). ABOi kidney transplantationis associated with very good long-term results provided pretransplant desensitization that relies on T-cell-targetedimmunosuppression and apheresis. The most specific and efficient apheresis is specific immunoadsorption with Glycosorb®columns. However, it is very costly (around 4000 euro/column, which is non-reusable). Each patient requires a few sessionprior to transplantation. In this study we demonstrate that using a single specific immunoadsorption column with treating largeplasma volumes (up to 18L) is very efficient, is associated with no isoagglutinin rebound and thereby might reduce dramaticallythe cost of ABOi desensitization.

Please cite this paper as: Rostaing L, Allal A, del Bello A, Sallusto F, Esposito L, Doumerc N, et al. Treatment of large plasmavolumes using specific immunoadsorption to desensitize ABO-incompatible kidney-transplant candidates. J Nephropathol.2016;5(3):90-97. DOI: 10.15171/jnp.2016.17

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ePublished: 29 Jun 2016
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