title: How to implement immunoadsorption in a polyvalent dialysis unit: a review.
abstract: BACKGROUND
  Many kidney-transplant candidates have anti-HLA alloantibodies (HLAi): these make transplantation difficult, even from a living kidney (LK) donor, because of the presence of donor-specific anti-HLA alloantibodies. Due to the shortage of deceased kidney donors, the number of LK transplants is increasing, but is potentially limited by ABO incompatibility (ABOi).
  
  
  OBJECTIVE
  To make ABOi and/or HLAi patients suitable for kidney transplantation they need to be desensitised: this strategy is mainly based on rituximab therapy combined with either plasmapheresis (PP) or immunoadsorption (IA). IA can be more efficient than PP because greater plasma volumes can be treated within a single session than a PP session (>4 vs. 1.5-2). IA can be specific (ABOi setting) or non-specific (HLAi).
  
  
  METHODS
  We describe how we designed and implemented a desensitisation programme based on IA. This was started in the first trimester of 2010 within the Acute Polyvalent Haemodialysis and Apheresis Unit in Toulouse University Hospital, France. So far, we have performed >200 IA sessions with good results.
  
  
  RESULTS
  The IA sessions were associated with a net body-weight gain of ∼1 kg. Normally, IA is performed first and then haemodialysis on the same or next day; however, we have been able to, for the first time, couple IA with haemodialysis. Moreover, we can now carry out this procedure 24 hours a day, seven days a week.
  
  
  CONCLUSIONS
  This procedure has improved patient care and reduced costs. The IA desensitisation programme has enabled successful transplantation in 24 patients to date.
authors.affiliation: Department of Nephrology, Dialysis, and Organ Transplantation, CHU Rangueil, Toulouse University Hospital, Toulouse Cédex 9, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Maggioni
authors.forename: Martine
authors.initials: M
authors.lastname: Hermelin
authors.forename: Eric
authors.initials: E
authors.lastname: Faubel
authors.forename: Asma
authors.initials: A
authors.lastname: Allal
authors.forename: Nassim
authors.initials: N
authors.lastname: Kamar
authors.forename: Lionel
authors.initials: L
authors.lastname: Rostaing
mesh_terms: D000017:ABO Blood-Group System; D000328:Adult; D000368:Aged; D001787:Blood Group Incompatibility / Q000097:blood* / Q000451:nursing* / Q000517:prevention & control; D005260:Female; D005602:France; D006680:HLA Antigens / Q000276:immunology*; D006284:Health Plan Implementation; D006436:Hemodialysis Units, Hospital; D006801:Humans; D007163:Immunosorbent Techniques / Q000295:instrumentation* / Q000451:nursing*; D007165:Immunosuppression Therapy / Q000451:nursing; D007518:Isoantibodies / Q000097:blood*; D016030:Kidney Transplantation / Q000295:instrumentation* / Q000451:nursing*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000451:nursing*; D014019:Tissue Donors
chemical_list: D000017:ABO Blood-Group System; D006680:HLA Antigens; D007518:Isoantibodies
keywords: Desensitisation; Haemodialysis; Immunoadsorption; Living kidney transplantation