title: Immunoadsorption and hemodialysis as a tandem procedure: a single-center experience of more than 60 procedures.
abstract: OBJECTIVE
  We have designed a desensitization program that gives good results and is cost effective for kidney-transplant patients who have a potential living donor, who are ABO incompatible (ABOi), and who may or may not have donor-specific alloantibodies (DSAs).
  
  
  METHODS
  Desensitization at pretransplant is based on immunosuppressants (such as rituximab, tacrolimus, and mycophenolic acid) and apheresis to retrieve potentially detrimental isoagglutinins and DSAs from blood. In 2011, we implemented immunoadsorption (IA) instead of plasmapheresis in our center as part of the desensitization protocol. Because IA is very tedious and time-consuming, we decided to perform IA and hemodialysis (HD) in tandem instead of performing these methods sequentially. Herein, we report on more than 100 of these tandem procedures and compare the results to those obtained when IA was performed before a HD session.
  
  
  RESULTS
  The tandem process resulted in nursing time being cut by half: from almost 10h30 min/patient to 6 h/patient. When IA was performed alone, body-weight gain was 1 kg (range 0 to 1.75) and the median volume of plasma treated per session was 6500 mL (range 4500 to 10 600). Conversely, during a tandem IA + HD session, the net median weight gain was -1.5 kg (range -4.1 to 0) and the median volume of plasma treated per session was 5000 mL (range 4000 to 8600). In addition, the tandem procedure was as well tolerated as that for IA followed by HD.
  
  
  CONCLUSIONS
  Tandem IA plus HD is a safe and cost-effective procedure.
authors.affiliation: 1 Department of Nephrology and Organ Transplantation, CHU Toulouse Rangueil, Toulouse - France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Maggioni
authors.forename: Asma
authors.initials: A
authors.lastname: Allal
authors.forename: Nassim
authors.initials: N
authors.lastname: Kamar
authors.forename: Martine
authors.initials: M
authors.lastname: Hermelin
authors.forename: Eric
authors.initials: E
authors.lastname: Faubel
authors.forename: Lionel
authors.initials: L
authors.lastname: Rostaing
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007163:Immunosorbent Techniques; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000628:therapy*; D016030:Kidney Transplantation / Q000379:methods; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D006435:Renal Dialysis / Q000379:methods*; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents