Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Sep;35(5):444-452.
doi: 10.1002/jca.21825. Epub 2020 Aug 17.

Effect of immunoadsorption alone or combined with membrane filtration on hemostasis parameters

Raphaël Marlu  1   2   3 , Hamza Naciri Bennani  3 , Landry Seyve  1 , Paolo Malvezzi  3 , Bénédicte Janbon  3 , Johan Noble  3 , Maryvonne Christophe  1 , Lionel Motte  3 , Farida Imerzoukene  3 , Eloi Chevallier  3 , Lionel Rostaing  3   4 , Thomas Jouve  3   4
Affiliations

Effect of immunoadsorption alone or combined with membrane filtration on hemostasis parameters

Raphaël Marlu et al. J Clin Apher. 2020 Sep.

Abstract

Introduction: ABO- or HLA-incompatible kidney transplantation is possible thanks to pretransplant antibody-depletion achieved by extracorporeal-treatment modalities. These methods induce depletion of some plasma proteins and may also impact on proteins involved in hemostasis.

Methods: To determine the impact of one session of immunoadsorption (IA) alone or combined with membrane filtration (MF) on clotting factors and natural anticoagulants, we performed a prospective, observational study on 13 patients waiting for HLA-/ABO-incompatible kidney transplants. Plasma hemostasis parameters were measured before and immediately after a first session of IA alone in six patients and of IA + MF in seven patients.

Results: IA alone induced depletion of fibrinogen and factor XIII (FXIII) whereas IA + MF caused greater depletion of all high-molecular-weight hemostatic proteins (fibrinogen, FV, FVIII, FXI, FXIII, von-Willebrand factor [VWF]). After an IA session, median reductions were 30% for fibrinogen and 43% for FXIII compared to baseline values. After a session of IA + MF, median decreases were 70% for fibrinogen, 54% for FV, 56% for FVIII, 37% for FXI, 78% for FXIII, and 62% for VWF. Noticeably, levels of low-molecular-weight factors (<100 kDa) were far less decreased than high-molecular-weight proteins with IA + MF, except for protein S and the tissue factor pathway inhibitor, which are known to be partially physiologically bound to high-molecular-weight molecules.

Conclusions: IA and IA + MF induced significant depletion of some proteins implicated in the hemostatic process; however, IA + MF resulted in stronger modifications to hemostasis parameters than IA alone. This may have potential clinical implications regarding bleeding risk, and particularly depletion of fibrinogen and FXIII.

Keywords: anti-HLA antibodies; coagulation; hemostasis; immunoadsorption; isoagglutinins; kidney transplantation; membrane filtration.

PubMed Disclaimer

References

REFERENCES

    1. Rostaing L, Karam B, Congy-Jolivet N, et al. Successful transplantation in ABO- and HLA-incompatible living kidney transplant patients: a report on 12 cases. Ther Apher Dial. 2016;20(5):507-516. https://doi.org/10.1111/1744-9987.12408.
    1. de Weerd AE, Betjes MGH. ABO-incompatible kidney transplant outcomes: a meta-analysis. Clin J Am Soc Nephrol. 2018;13(8):1234-1243. https://doi.org/10.2215/CJN.00540118.
    1. Lo P, Sharma A, Craig JC, et al. Preconditioning therapy in ABO-incompatible living kidney transplantation: a systematic review and meta-analysis. Transplantation. 2016;100(4):933-942. https://doi.org/10.1097/TP.0000000000000933.
    1. Rostaing LP, Malvezzi P. HLA-incompatible kidney transplantation-worth the risk? N Engl J Med. 2016;374(10):982-984. https://doi.org/10.1056/NEJMe1601379.
    1. Orandi BJ, Luo X, Massie AB, et al. Survival benefit with kidney transplants from HLA-incompatible live donors. N Engl J Med. 2016;374(10):940-950. https://doi.org/10.1056/NEJMoa1508380.

Grants and funding

LinkOut - more resources