Efficacy of plasmapheresis on donor-specific antibody reduction by HLA specificity in post-kidney transplant recipients.
BACKGROUND
Donor-specific antibodies (DSAs) to HLA antigens can cause acute antibody-mediated rejection (AMR) after kidney transplantation (Txp). Therapeutic plasma exchange (TPE) has been used for AMR treatment; however, DSA reduction rates are inconsistent. We investigated DSA reduction rates by HLA specificity and clinical outcome.


METHODS
Sixty-four courses of TPE for 56 kidney Txp recipients with high DSA were investigated. Dates of TPE procedures and Txp, patients' age, sex, race, creatinine (Cr), and mean fluorescent intensity (MFI) of DSA were retrieved. MFI reduction rate after one to three TPE and four to six TPE procedures were calculated by HLA DSA specificity in each patient, and the mean reduction rates were compared. The relationship of TPE treatment, MFI or Cr improvement rate, and graft age was also investigated.


RESULTS
Patients received a mean 6.0 TPE procedures. Most received intravenous immunoglobulin after TPE and immunosuppressives. Forty-two cases (65.6%) had DSA to HLA Class I and 54 cases (84.4%) to Class II, including 32 cases (50.0%) to both. Mean MFI reduction rates after one to three TPE and four to six TPE procedures were 25.7 and 37.1% in HLA Class I, 25.1 and 34.2% in Class II, and 14.3 and 19.9% in DR51-53. The mean Cr improvements at the end of TPE and 3 and 6 months after TPE were 3.41, -0.37, and -0.72%, respectively.


CONCLUSIONS
Six TPE procedures decreased DSA more than three TPE procedures, but reduction rate was lower by the second three TPE procedures than the first three TPE procedures. Although the mean Cr improvement was minimal, the treatment has good potential to stop further deterioration of kidney function. Better Cr improvement rate is correlated with the graft age.
Transfusion Medicine Division, Department of Pathology, University of Michigan, Ann Arbor, Michigan.
Chisa
C
Yamada
Histocompatibility Lab Division, Department of Pathology, University of Michigan, Ann Arbor, Michigan.
Daniel S
DS
Ramon
Transplant Biology Division, Department of Surgery, Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan.
Marilia
M
Cascalho
General Surgery Division, Department of Surgery, University of Michigan, Ann Arbor, Michigan.
Randall S
RS
Sung
Nephrology Division, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
Alan B
AB
Leichtman
Nephrology Division, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
Milagros
M
Samaniego
Transfusion Medicine Division, Department of Pathology, University of Michigan, Ann Arbor, Michigan.
Robertson D
RD
Davenport
D000918:Antibody Specificity; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003404:Creatinine / Q000097:blood; D006084:Graft Rejection / Q000097:blood / Q000188:drug therapy / Q000276:immunology / Q000628:therapy*; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007518:Isoantibodies / Q000097:blood / Q000276:immunology*; D016030:Kidney Transplantation; D010951:Plasma Exchange; D010956:Plasmapheresis; D012189:Retrospective Studies; D013601:T-Lymphocytes / Q000276:immunology; D016896:Treatment Outcome
D000961:Antilymphocyte Serum; D006680:HLA Antigens; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D007518:Isoantibodies; D003404:Creatinine