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Tytuł:
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Double-Filtration Plasmapheresis Plus Low-Dose Anti-thymocyte Globulin and Tacrolimus in Asian Living-Donor Kidney Transplantation With Donor-Specific Anti-HLA Antibody.
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Autorzy:
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Kantachuvesiri S; Division of Nephrology, Department of Medicine, Ramathibodi Hospital, Phyathai, Bangkok Thailand. Electronic address: .
Ingsathit A; Division of Nephrology, Department of Medicine, Ramathibodi Hospital, Phyathai, Bangkok Thailand; Section for Clinical Epidemiology and Biostatistics, Ramathibodi Hospital, Phyathai, Bangkok, Thailand.
Thammanichanond D; Histocompatibility and Immunogenetics Laboratory, Department of Pathology, Ramathibodi Hospital, Phyathai, Bangkok, Thailand.
Choochaeam K; Division of Clinical Pharmacy, Department of Pharmacy, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Sra-Ium S; Division of Clinical Pharmacy, Department of Pharmacy, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Kitiyakara C; Division of Nephrology, Department of Medicine, Ramathibodi Hospital, Phyathai, Bangkok Thailand.
Nongnuch A; Division of Nephrology, Department of Medicine, Ramathibodi Hospital, Phyathai, Bangkok Thailand.
Sakulchairungrueng B; Vascular and Transplantation Unit, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Worawichawong S; Histocompatibility and Immunogenetics Laboratory, Department of Pathology, Ramathibodi Hospital, Phyathai, Bangkok, Thailand.
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Źródło:
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Transplantation proceedings [Transplant Proc] 2021 Apr; Vol. 53 (3), pp. 995-1000. Date of Electronic Publication: 2020 Sep 15.
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Publication: New York, N.Y. : Elsevier Science Inc.
Original Publication: New York Stratton.
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MeSH Terms:
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Kidney Transplantation*/adverse effects
Kidney Transplantation*/methods
Antilymphocyte Serum/*therapeutic use
Graft Rejection/*prevention & control
Immunosuppression Therapy/*methods
Plasmapheresis/*methods
Tacrolimus/*therapeutic use
Adult ; Asian People ; Cohort Studies ; Female ; Graft Rejection/immunology ; Humans ; Immunosuppressive Agents/therapeutic use ; Isoantibodies/immunology ; Living Donors ; Male ; Middle Aged ; Postoperative Complications/prevention & control ; Retrospective Studies ; Transplant Recipients ; Young Adult
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Substance Nomenclature:
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0 (Antilymphocyte Serum)
0 (Immunosuppressive Agents)
0 (Isoantibodies)
WM0HAQ4WNM (Tacrolimus)
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Entry Date(s):
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Date Created: 20200919 Date Completed: 20210608 Latest Revision: 20221207
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Update Code:
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20240104
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DOI:
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10.1016/j.transproceed.2020.08.019
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PMID:
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32948312
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Background: Pretransplant desensitization protocols, including plasmapheresis, intravenous immunoglobulin, induction antibody therapy, and intensive maintenance immunosuppression, are generally employed in kidney transplant recipients who have positive status for donor-specific anti-HLA antibody (DSA). To avoid serious infectious complications, the authors designed a novel low-dose protocol in Thai patients undergoing DSA+ living-related kidney transplantation (LRKT).
Methods: A retrospective cohort study of the patients who underwent DSA+ LRKT was conducted. The novel protocol consisted of 3 to 5 sessions of pretransplant double-filtration plasmapheresis (DFPP) with or without low-dose intravenous immunoglobulin together with low-dose anti-thymocyte globulin (ATG) induction (1-1.5 mg/kg/d for 3-4 days) and low-dose tacrolimus (Tac) (trough level 5-10 ng/mL), mycophenolate, and prednisolone.
Results: The study included 17 patients. The lymphocyte crossmatch via complement-dependent cytotoxicity was negative in 12 patients and positive for B cell immunoglobulin M in 5 patients. The novel desensitization protocol resulted in a decrease of at least 50% of DSA mean fluorescence intensity from baseline (from 4320 ± 549 before DFPP to 1601 ± 350 before transplantation, P < .005) and successful kidney transplantation with good allograft function in all cases. Early DSA rebound was observed in 3 patients after transplantation, and kidney biopsy revealed subclinical antibody-mediated rejection in 1 patient and diffuse C4d staining without cell infiltration in 2 patients. There were good long-term outcomes in patient and graft survival (100% and 94.1%, respectively). Only 1 allograft loss occurred because of nonadherence. The majority of patients have stable allograft function with serum creatinine less than 1.5 mg/dL. However, infections, including CMV and other organisms, were commonly observed.
Conclusions: Desensitization protocol with DFPP, low-dose ATG, and Tac provides excellent outcomes in living donor kidney transplantation in highly sensitized Asian populations.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
