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. 2021 Mar 23;10(6):1316.
doi: 10.3390/jcm10061316.

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

Johan Noble  1   2 , Antoine Metzger  1 , Hamza Naciri Bennani  1 , Melanie Daligault  1 , Dominique Masson  3 , Florian Terrec  1 , Farida Imerzoukene  1 , Beatrice Bardy  3 , Gaelle Fiard  4   5 , Raphael Marlu  6 , Eloi Chevallier  1 , Benedicte Janbon  1 , Paolo Malvezzi  1 , Lionel Rostaing  1   2 , Thomas Jouve  1   2
Affiliations

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

Johan Noble et al. J Clin Med. .

Abstract

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.

Keywords: desensitization; donor specific antibody; kidney transplantation; plasmapheresis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Desensitization and immunosuppression protocol for HLA-incompatible kidney transplantation. Panel (A) shows the protocol for living donors HLAi kidney transplantation. Panel (B) shows the protocol for deceased donors HLAi kidney transplantation. IAss: semi-specific immunoadsorption; DFPP: double-filtration plasmapheresis; PE: plasma exchange.
Figure 2
Figure 2
Post session reduction of immunoglobulin-G according to the apheresis technique. DFPP: double-filtration plasmapheresis; PE: plasma exchange; IA: immunoadsorption; IgG: immunoglobulin subtype G. IgG reduction was assessed in all sessions that did not received IV immunoglobulins. The volume of purified plasma is significantly associated with IgG reduction.
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