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Abstract
Aim: To analyze the results of the non-selective immunoadsorption technique in a hospital hemodialysis unit.
Material and methods: Retrospective descriptive study of the first 18 patients treated in our center with non-selective immunoadsorption (years 2012-2017) in the indications for ABOi transplant conditioning and treatment of humoral rejection.
Results: During a period of 5 years, 128 non-selective immunoadsorption sessions were analyzed. 38.9% (n = 7) of cases for desensitization prior to renal transplantation with incompatibility of blood group and 61.1% (n = 11) remaining for the treatment of antibody-mediated rejection.
In the first case, an average of 8 ± 0.6 sessions of immunoadsorption prior to kidney transplantation were performed and 57.1% were complemented by 2 subsequent sessions. The concomitant treatment was protocolled with Rituximab and immunoglobulins, 57.1% requiring plasma exchanges. In the second case, an average of 5.9 ± 2 immunoadsorption sessions were carried out. The concomitant treatment was the same and 27.3% performed plasma exchanges.
Conclusions: Kidney transplantation from ABOI living donor after desensitization was possible in 100% of patients. 72.7% of patients treated for antibody-mediated rejection currently maintain graft functionality.
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References
- Schwartz J, Winters JL, Padmanabhan A, Balogun RA, Delaney M, Linenberger ML. Guías sobre el uso de la Aféresis Terapéutica en la práctica clínica. Enfoque basado en la evidencia del Comité de Redacción de la Sociedad Americana de Aféresis: sexta edición especial. Revista de aféresis clínica. 2013;28:145-284.
- Schwartz J, Winters JL, Padmanabhan A, Balogun Mayordomo A, Barranco A, Sobrado MªP, Caamaño C, Montoya A, Vives A. Inmunoadsorción: descripción de una nueva técnica. Enferm Nefrol. 2013; 16(1):221-4.
- Oppenheimer F, Revuelta I, Serra N, Lozano M, Gutérrez-Dalmau A, Esforzado N et al. Trasplane renal ABO incompatible: de un sueño a una realidad. Experiencia del Hospital Clínic de Barcelona. Nefrología. 2010;30(1):54-63.
- Fernández C, Calvo M, Leite N, López A, Ferreiro T, Ribera R et al. Trasplante renal procedente de donante vivo HLA incompatible: Eficacia y pronóstico en 32 pacientes tras desensibilización. Nefrología. 2017;37(6):638-45.
- Tydén G, Kumlien G, Genberg H, Sanberg J, Lundgren T, Fehrman I. ABO incompatible kidney transplantations without splenectomy, using antigen-specific immunoadsorption and rituximab. Am J Transplant. 2005;5(1):145-8.
- Seija M, Nin M, Astesiano R, Coitiño R, Santiago J, Ferrari S et al. Rechazo agudo del trasplante renal: diagnóstico y alternativas terapéuticas. Nefrol Latinoam. 2017;14(4):119-30.
- Pérez R, Llorente E, Agüero J.I, Briceño G, Gálvez MªA, Bravo MI. Tratamiento del rechazo agudo hiperinmune con plasmaféresis y rituximab. Nuestra experiencia. Enferm Nefrol. 2012;15(2):146-60.
- Tydén G, Kumlien G, Genberg H, Sanberg J, Lundgren T, Fehrman I. ABO incompatible kidney transplantations without splenectomy, using antigen-specific immunoadsorption and rituximab. Am J Transplant. 2005;5(1):145-8.
- Genberg H, Kumlien G, Wennberg L, Berg U, Tydén G. ABO-incompatible kidney transplantation using antigen-specific immunoadsorption and rituximab: a 3-year follow-up. Transplantation. 2008;85(12): 1745-54.
- Haidinger M, Schmaldienst S, Körmöczi G, Regele H, Soleiman A, Schawartz D et al. Vienna experience of ABO-incompatible living-donor kidney transplantation. Wien Klin Wochenschr. 2009;121(7-8): 247-55.
- Morath C, Becker LE, Leo A, Beimler J, Klein K, Seckinger J et al. ABO-incompatible kidney transplantation enabled by non-antigen-specific immunoadsorption. Transplantation. 2012;93(8):827-34.
- Becker LE, Siebert D, Süsal C, Opelz G, Leo A, Waldherr R et al. Outcomes Following ABO-Incompatible Kidney Transplantation Performed After Desensitization by Nonantigen-Speficic Immunoadsorption. Transplantation. 2015;99(11):2364-71.
- Böhmig GA, Regele H, Exner M, Derhartunian V, Kletzmayr J, Säemann MD et al. C4d-positive acute humoral renal allograft rejection: effective treatment by immunoadsorption. J Am Soc Nephrol. 2001;12(11):2482-9.
- Ji SM, Liu ZH, JS Chen, GZ Sha, Ji DX, Li LS. Rescue therapy by immunoadsorption in combination with tacrolimus and mycophenolate mofetil for C4d-positive acute humoral renal allograft rejection. Transplant Proc. 2006;38(10):3459-63.
References
Schwartz J, Winters JL, Padmanabhan A, Balogun RA, Delaney M, Linenberger ML. Guías sobre el uso de la Aféresis Terapéutica en la práctica clínica. Enfoque basado en la evidencia del Comité de Redacción de la Sociedad Americana de Aféresis: sexta edición especial. Revista de aféresis clínica. 2013;28:145-284.
Schwartz J, Winters JL, Padmanabhan A, Balogun Mayordomo A, Barranco A, Sobrado MªP, Caamaño C, Montoya A, Vives A. Inmunoadsorción: descripción de una nueva técnica. Enferm Nefrol. 2013; 16(1):221-4.
Oppenheimer F, Revuelta I, Serra N, Lozano M, Gutérrez-Dalmau A, Esforzado N et al. Trasplane renal ABO incompatible: de un sueño a una realidad. Experiencia del Hospital Clínic de Barcelona. Nefrología. 2010;30(1):54-63.
Fernández C, Calvo M, Leite N, López A, Ferreiro T, Ribera R et al. Trasplante renal procedente de donante vivo HLA incompatible: Eficacia y pronóstico en 32 pacientes tras desensibilización. Nefrología. 2017;37(6):638-45.
Tydén G, Kumlien G, Genberg H, Sanberg J, Lundgren T, Fehrman I. ABO incompatible kidney transplantations without splenectomy, using antigen-specific immunoadsorption and rituximab. Am J Transplant. 2005;5(1):145-8.
Seija M, Nin M, Astesiano R, Coitiño R, Santiago J, Ferrari S et al. Rechazo agudo del trasplante renal: diagnóstico y alternativas terapéuticas. Nefrol Latinoam. 2017;14(4):119-30.
Pérez R, Llorente E, Agüero J.I, Briceño G, Gálvez MªA, Bravo MI. Tratamiento del rechazo agudo hiperinmune con plasmaféresis y rituximab. Nuestra experiencia. Enferm Nefrol. 2012;15(2):146-60.
Tydén G, Kumlien G, Genberg H, Sanberg J, Lundgren T, Fehrman I. ABO incompatible kidney transplantations without splenectomy, using antigen-specific immunoadsorption and rituximab. Am J Transplant. 2005;5(1):145-8.
Genberg H, Kumlien G, Wennberg L, Berg U, Tydén G. ABO-incompatible kidney transplantation using antigen-specific immunoadsorption and rituximab: a 3-year follow-up. Transplantation. 2008;85(12): 1745-54.
Haidinger M, Schmaldienst S, Körmöczi G, Regele H, Soleiman A, Schawartz D et al. Vienna experience of ABO-incompatible living-donor kidney transplantation. Wien Klin Wochenschr. 2009;121(7-8): 247-55.
Morath C, Becker LE, Leo A, Beimler J, Klein K, Seckinger J et al. ABO-incompatible kidney transplantation enabled by non-antigen-specific immunoadsorption. Transplantation. 2012;93(8):827-34.
Becker LE, Siebert D, Süsal C, Opelz G, Leo A, Waldherr R et al. Outcomes Following ABO-Incompatible Kidney Transplantation Performed After Desensitization by Nonantigen-Speficic Immunoadsorption. Transplantation. 2015;99(11):2364-71.
Böhmig GA, Regele H, Exner M, Derhartunian V, Kletzmayr J, Säemann MD et al. C4d-positive acute humoral renal allograft rejection: effective treatment by immunoadsorption. J Am Soc Nephrol. 2001;12(11):2482-9.
Ji SM, Liu ZH, JS Chen, GZ Sha, Ji DX, Li LS. Rescue therapy by immunoadsorption in combination with tacrolimus and mycophenolate mofetil for C4d-positive acute humoral renal allograft rejection. Transplant Proc. 2006;38(10):3459-63.