title: Efficacy and safety of tandem hemodialysis and immunoadsorption to desensitize kidney transplant candidates.
abstract: OBJECTIVE
  We conducted a desensitization program in our center in patients undergoing kidney transplant for end-stage renal disease. These patients had a living-donor either ABO incompatible and/or human-leukocyte antigen-incompatible. The safety and efficacy of this program were evaluated.
  
  
  METHODS
  A pretransplant desensitization program relies on immunosuppressants and apheresis to remove detrimental antibodies. We chose immunoadsorption as the apheresis technique, and coupled this with hemodialysis in a tandem procedure.
  
  
  RESULTS
  We report on the efficacy of this new method in 120 procedures performed in 20 patients (14 ABO incompatible, 6 ABO incompatible/human leukocyte antigen-incompatible). The tandem procedure was well tolerated, and saved time compared with conducting sequential immunoadsorption and hemodialysis (6 h vs 10 h). The tandem procedure was associated with significantly decreased isoagglutinin titers and donor-specific alloantibodies (assessed by mean fluorescence intensity). Dialysance was effective (183, 102-264). The biochemical and hematologic parameters were similar to those observed after a conventional hemodialysis session, with the exception of protidemia; this might be related to some degree of albumin loss during the immunoadsoprtion procedure. The posttransplant events included 1) one ABO incompatible / human leukocyte antigenincompatible patient with vein thrombosis and ultimate kidney loss; 2) two patients with steroidsensitive cellular acute rejection; and 3) two patients with acute antibody-mediated rejection, which was successfully treated with apheresis and steroid pulses, plus rituximab in one and eculizumab in the other.
  
  
  CONCLUSIONS
  We conclude that the tandem immunoadsorption-hemodialysis procedure is efficient at desensitizing patients with end-stage renal disease who are candidates for a living ABO incompatible and/or human leukocyte antigenincompatible donor-kidney transplant.
authors.affiliation: From the Department of Nephrology and Organ Transplantation, University Hospital Toulouse, France; the Department of Urology, Transplantation, and Andrology; and the INSERM U563, IFR-BMT, CHU Purpan, Toulouse, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Rostaing
authors.forename: Sébastien
authors.initials: S
authors.lastname: Maggioni
authors.forename: Corinne
authors.initials: C
authors.lastname: Hecht
authors.forename: Martine
authors.initials: M
authors.lastname: Hermelin
authors.forename: Eric
authors.initials: E
authors.lastname: Faudel
authors.forename: Nassim
authors.initials: N
authors.lastname: Kamar
authors.forename: Federico
authors.initials: F
authors.lastname: Sallusto
authors.forename: Nicolas
authors.initials: N
authors.lastname: Doumerc
authors.forename: Asma
authors.initials: A
authors.lastname: Allal
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D001781:Blood Component Removal / Q000009:adverse effects / Q000379:methods*; D001787:Blood Group Incompatibility / Q000097:blood / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D003888:Desensitization, Immunologic / Q000009:adverse effects / Q000379:methods*; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology*; D006648:Histocompatibility; D006650:Histocompatibility Testing; D006801:Humans; D007164:Immunosorbents / Q000009:adverse effects / Q000627:therapeutic use*; D007518:Isoantibodies / Q000097:blood; D007676:Kidney Failure, Chronic / Q000097:blood / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D016030:Kidney Transplantation / Q000009:adverse effects; D015397:Program Evaluation; D006435:Renal Dialysis / Q000009:adverse effects; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System; D006680:HLA Antigens; D007164:Immunosorbents; D007518:Isoantibodies