TRADITIONAL AND CASCADE PLASMAPHERESIS IN ANTIBODY TITERS’ REDUCTION IN RENAL TRANSPLANT RECIPIENTS

Introduction. One of the current tasks of transplantology is to overcome «graft-host» immune confl ict. Partially this confl ict is caused by the presence of circulating pre-existing antibodies. Highly sensitized patients have a greater risk of rejection and subsequent graft loss. There are several methods to remove the antibodies, one of which is a double fi ltration plasmapheresis (DFPF). This report presents our experience of DFPF in recipients of high immunologic risk.

Aim: to compare the effectiveness of traditional and double filtration plasmapheresis in desensitization of patients with high risk of immunological complications.

Methods. The study included 30 patients after kidney transplantation. All patients were classifi ed as high-immunologic risk group. In 15 patients of study group we performed DFPF, in 15 patients of comparison group – traditional plasmapheresis. We monitored the immune status: markers of humoral immunity activation – IgG, IgM, IgA before and after the procedures. DFPF procedure was performed on OctoNova (MeSys, Germany) with a plasmafi lter and plasma components separator. Protocol biopsies were performed on days 30 and 90.

Results. The concentration of antibodies may be effectively reduced with DFPF. Total IgM and IgG antibodies were reduced by 30–55% of the original level. There was a less albumin loss in case of DFPF application. There is 1 patient with antibody-mediated rejection with graft dysfunction in study group. There are no signs of rejection in 30- and 90-day biopsy in study group. But there were three patients with subclinical antibody-mediated rejection in the comparison group.

Conclusion. DFPF can safely and effectively reduce the high titers of antibodies that are responsible for humoral rejection of renal allograft. Reduction of antibodies in sensitized patients immediately after transplantation may improve graft function.

1. Naesens M., Lerut E., Sarwal M. et al. Balancing efficacy and toxicity of kidney transplant immunosuppression. Transplant Proc. 2009; 41 (8): 3393–3395.

2. Каабак М.М., Горяйнов В.А., Зокоев А.К. и др. Десятилетний опыт применения раннего плазмафереза после пересадки почки. Вестник трансплантологии и искусственных органов. 2009; 11 (1):28–33. Kaabak M.M., Gorjajnov V.A., Zokoev A.K. et al. Tenyear experience of early plasmapheresis after kidney transplantation. Vestnik transplantologii i iskusstvennyh organov. 2009; 11 (1): 28–33. [In Rus]

3. Садовников В.И., Сандриков В.А., Каабак М.М. и др. Влияние плазмафереза на функцию и внутриорганный кровоток почечного аллотрансплантата в раннем послеоперационном периоде. Вестник трансплантологии и искусственных органов. 2003; 3:21–30. Sadovnikov V.I., Sandrikov V.A., Kaabak M.M. et al. Effect of plasmapheresis on the function and renal allograft intraorganic blood fl ow in the early postoperative period. Vestnik transplantologii i iskusstvennyh organov. 2003; 3: 21–30. [In Rus]

4. Shah A., Nadasdy T., Arend L. et al. Treatment of C4dpositive acute humoral rejection with plasmapheresis and rabbit polyclonal antithymocyte globulin. Transplantation. 2004; 77 (9): 1399–1405.

5. White B. Plasmapheresis in the treatment of acute vascular rejection: an experience on a dialysis unit. J Ren Care. 2006; 32 (4): 208–209.

6. Bartel G., Schwaiger E., Böhmig G.A. Prevention and treatment of alloantibody-mediated kidney transplant rejection. Transpl Int. 2011; 24 (12): 1142–1155.

7. Ibernón M., Gil-Vernet S., Carrera M. et al. Therapy with plasmapheresis and intravenous immunoglobulin for acute humoral rejection in kidney transplantation. Transplant Proc. 2005; 37 (9): 3743–3745.

8. Ward D.M. Conventional apheresis therapies: A review. J Clin Apher. 2011; 26 (5): 230–238.

9. Lennertz A., Fertmann J., Thomae R. et al. Plasmapheresis in C4d-positive acute humoral rejection following kidney transplantation: a review of 4 cases. Ther Apher Dial. 2003; 7 (6): 529–535.

10. Marks S. Therapeutic plasmapheresis: recognizing complications as soon as possible. Pfl ege Z. 2005; 58 (11): 696–698.

11. Pruijm M.T., Vogt B., Cherpillod A. Plasmapheresis, a safe treatment when applied to the correct indication and with awareness of the complications. Ned. Tijdschr Geneeskd. 2008; 152 (42): 2261–2266.

12. Gungor O., Sen S., Kircelli F. et al. Plasmapheresis therapy in renal transplant patients: five-year experience. Transplant Proc. 2011; 43 (3): 853–857.

13. Higgins R., Lowe D., Hathaway M. et al. Double fi ltration plasmapheresis in antibody-incompatible kidney transplantation. Ther Apher Dial. 2010; 14 (4): 392–399.

14. Tanabe K. Double-filtration plasmapheresis. Transplantation. 2007; 84 (12 Suppl): S30–32.

15. Matsuo N., Yamamoto H., Kobayashi A. et al. A case of accelerated acute rejection after ABO-compatible living unrelated kidney transplantation. Clin Transplant. 2009; Suppl. 20: 23–26.

16. Tanabe K., Tokumoto T., Ishida H. et al. ABO-incompatible renal transplantation at Tokyo Women's Medical University. Clin Transpl. 2003; 2003: 175–181.

17. Uchida J., Iwai T., Kato M. et al. A novel approach to successful ABO-incompatible high-titer renal transplantation. Transplant Proc. 2008; 40 (7): 2285–2288.