title: Non-tolerability of double-filtration plasmapheresis in antibody-incompatible kidney transplant candidates.
abstract: Few studies have reported the use of double-filtration plasmapheresis (DFPP) in antibody-incompatible kidney transplantation. To assess the efficiency and tolerability of DFPP, we prospectively studied four chronic hemodialysis patients from two centers undergoing antibody-incompatible kidney transplantation. DFPP was used for ABO-incompatible transplantation (n = 1), for high human leukocyte antigen (HLA) immunization levels (n = 2) or for the presence of a donor-specific antibody (DSA) against a potential living donor (n = 1). In all the patients, the DFPP program was discontinued because of the adverse effects. Low blood pressure occurred during the first hour of the session in all the patients. A significant loss of plasma proteins, clotting factors and immunoglobulins also occurred during this treatment. In addition, fistula thrombosis was diagnosed in two patients. Three patients experienced gastrointestinal symptoms. The DFPP reduced the titers of the anti-B antibodies and reduced the levels of DSA in one patient, but had no effect on anti-HLA antibodies in the remaining two patients. Our study highlights the non-tolerability and poor efficacy of DFPP prior to antibody-incompatible kidney transplantation that limit its extensive use in the desensitization protocols.
authors.forename: Hadia
authors.initials: H
authors.lastname: Hebibi
authors.forename: Hugo
authors.initials: H
authors.lastname: Weclawiak
authors.forename: Lionel
authors.initials: L
authors.lastname: Rostaing
authors.forename: Séverine
authors.initials: S
authors.lastname: Beaudreuil
authors.forename: Asma
authors.initials: A
authors.lastname: Allal
authors.forename: Hélène
authors.initials: H
authors.lastname: François
authors.forename: Antoine
authors.initials: A
authors.lastname: Durrbach
authors.affiliation: Department of Nephrology, Dialysis and Organ Transplantation, CHU Rangueil; INSERM U1043, IFR-BMT, CHU Purpan Toulouse, France.
authors.forename: Nassim
authors.initials: N
authors.lastname: Kamar
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D015415:Biomarkers / Q000097:blood; D001787:Blood Group Incompatibility / Q000097:blood / Q000276:immunology / Q000517:prevention & control*; D005602:France; D006680:HLA Antigens / Q000276:immunology*; D006648:Histocompatibility; D006801:Humans; D007518:Isoantibodies / Q000097:blood*; D016030:Kidney Transplantation; D008297:Male; D010956:Plasmapheresis / Q000009:adverse effects* / Q000379:methods; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System; D015415:Biomarkers; D006680:HLA Antigens; D007518:Isoantibodies