Author/Authors :
Hebibi, Hadia Centre Hospitalier Universitaire (CHU), Kremlin Bicêtre - Department of Nephrology, Dialysis and Organ Transplantation, France , Weclawiak, Hugo Centre Hospitalier Universitaire (CHU), Rangueil - Department of Nephrology, Dialysis and Organ Transplantation, France , Rostaing, Lionel Centre Hospitalier Universitaire (CHU), Rangueil - Department of Nephrology, Dialysis and Organ Transplantation, France , Rostaing, Lionel Centre Hospitalier Universitaire (CHU), Toulouse - Institut National de la Santé et de la Recherche Médicale (INSERM), France , Beaudreuil, Séverine Centre Hospitalier Universitaire (CHU), Kremlin Bicêtre - Department of Nephrology, Dialysis and Organ Transplantation, France , Allal, Asma Centre Hospitalier Universitaire (CHU), Rangueil - Department of Nephrology, Dialysis and Organ Transplantation, France , François, Hélène Centre Hospitalier Universitaire (CHU), Kremlin Bicêtre - Institut National de la Santé et de la Recherche Médicale (INSERM) - Department of Nephrology, Dialysis and Organ Transplantation, France , Durrbach, Antoine Centre Hospitalier Universitaire (CHU), Kremlin Bicêtre - Institut National de la Santé et de la Recherche Médicale (INSERM) - Department of Nephrology, Dialysis and Organ Transplantation, France , Kamar, Nassim Centre Hospitalier Universitaire (CHU), Rangueil - Department of Nephrology, Dialysis and Organ Transplantation, France , Kamar, Nassim Centre Hospitalier Universitaire (CHU), Toulouse - Institut National de la Santé et de la Recherche Médicale (INSERM), France
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.
