Treatment of antibody‐mediated rejection with double‐filtration plasmapheresis, low dose IVIg plus rituximab after kidney transplantation

2021 ◽  
Author(s):  
Hamza Naciri Bennani ◽  
Mélanie Daligault ◽  
Johan Noble ◽  
Béatrice Bardy ◽  
Lionel Motte ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Low Dose ◽  
Antibody Mediated Rejection ◽  
Double Filtration Plasmapheresis ◽  
Double Filtration

scholarly journals SP811EFFECT OF DOUBLE-FILTRATION PLASMAPHERESIS FOR CHRONIC ANTIBODY-MEDIATED REJECTION ON COAGULATION PARAMETERS

2017 ◽  
Vol 32 (suppl_3) ◽  
pp. iii416-iii416
Author(s):  
Paolo Malvezzi ◽  
Raphaël Marlu ◽  
Landry Seyve ◽  
Jocelyne Maurizzi ◽  
Pierre-Louis Carron ◽  
...  
Keyword(s):  
Coagulation Parameters ◽  
Antibody Mediated Rejection ◽  
Double Filtration Plasmapheresis ◽  
Double Filtration

Reducing Fibrinogen and Factor XIII Using Double-Filtration Plasmapheresis for Antibody-Mediated Rejection: Predictive Models

2018 ◽  
Vol 46 (3) ◽  
pp. 239-245 ◽  
Author(s):  
Thomas Jouve ◽  
Raphaël Marlu ◽  
Paolo Malvezzi ◽  
Landry Seyve ◽  
Jocelyne Maurizi ◽  
...  
Keyword(s):  
Factor Xiii ◽  
Prospective Trial ◽  
Human Leukocyte ◽  
Kidney Transplant Recipients ◽  
Clotting Factors ◽  
Leukocyte Antigen ◽  
Antibody Mediated Rejection ◽  
Double Filtration Plasmapheresis ◽  
Before And After ◽  
Double Filtration

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]). Methods: 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. Results: 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. Conclusion: 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.

scholarly journals Apheresis Efficacy and Tolerance in the Setting of HLA-Incompatible Kidney Transplantation

2021 ◽  
Vol 10 (6) ◽  
pp. 1316
Author(s):  
Johan Noble ◽  
Antoine Metzger ◽  
Hamza Naciri Bennani ◽  
Melanie Daligault ◽  
Dominique Masson ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Adverse Events ◽  
Mean Fluorescence Intensity ◽  
Single Center ◽  
Hla Antibodies ◽  
Specific Antibodies ◽  
Double Filtration Plasmapheresis ◽  
Donor Specific Antibodies ◽  
Double Filtration ◽  
Hla Incompatible

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 (p = 0.04, p = 0.02). IA, PE, and a lower maximal DSA MFI were associated with a greater decrease in intra-session class II DSA (p < 0.01). Safety was good: severe adverse events occurred in 17 sessions (1.9%), more frequently with DFPP (6.5%) p < 0.01. Hypotension occurred in 154 sessions (17.5%), more frequently with DFPP (p < 0.01). Apheresis is well tolerated (IA and PE > DFPP) and effective at removing HLA antibodies and allows HLAi KT for sensitized patients.

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