Efficacy and safety of tandem hemodialysis and immunoadsorption to desensitize kidney transplant candidates

• Published in: Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation Vol. 13 Suppl 1; p. 165
• Main Authors: Rostaing, Lionel, Maggioni, Sébastien, Hecht, Corinne, Hermelin, Martine, Faudel, Eric, Kamar, Nassim, Sallusto, Federico, Doumerc, Nicolas, Allal, Asma
• Format: Journal Article
• Language: English
• Published: Turkey 01-04-2015
• Subjects: ABO Blood-Group System - immunology; Blood Component Removal - adverse effects; Blood Component Removal - methods; Blood Group Incompatibility - blood; Blood Group Incompatibility - diagnosis; Blood Group Incompatibility - immunology; Blood Group Incompatibility - therapy; Desensitization, Immunologic - adverse effects; Desensitization, Immunologic - methods; Graft Rejection - immunology; Graft Rejection - prevention & control; Graft Survival; Histocompatibility; Histocompatibility Testing; HLA Antigens - immunology; Humans; Immunosorbents - adverse effects; Immunosorbents - therapeutic use; Isoantibodies - blood; Kidney Failure, Chronic - blood; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - immunology; Kidney Failure, Chronic - therapy; Kidney Transplantation - adverse effects; Program Evaluation; Renal Dialysis - adverse effects; Risk Factors; Time Factors; Treatment Outcome
• ISSN: 2146-8427
• DOI: 10.6002/ect.mesot2014.O146

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.