Resultados de la inmnoadsorción en el trasplante ABOi y el rechazo humoral en una unidad de hemodiáisis hospitalaria / Results of immunoadsorption in the ABOi kidney transplantation and humoral rejection in a hospital hemodialysis unit

Introducción: El tratamiento con inmunoadsorción no selectiva fue introducido en nuestra unidad de hemodiálisis hospitalaria con el objetivo de permitir la desensibilización previa a un trasplante renal con incompatibilidad de grupo sanguíneo y el tratamiento del rechazo mediado por anticuerpos. Objetivo: Analizar los resultados de la técnica de inmunoadsorción no selectiva, en una unidad de hemodiálisis hospitalaria. Material y Método: Estudio retrospectivo, descriptivo, de los primeros 18 pacientes tratados en nuestro centro con inmunoadsorción no selectiva (años 2012-2017) en las indicaciones de acondicionamiento del trasplante ABOi y tratamiento del rechazo humoral. Resultados: Durante un periodo de 5 años se analizaron un total de 128 sesiones de inmunoadsorción no selectiva. El 38,9% (n=7) de los casos para desensibilización previa al trasplante renal con incompatibilidad de grupo sanguíneo y el 61,1% (n=11) restante para el tratamiento del rechazo mediado por anticuerpos. En el primer caso, realizaron una media de 8±0,6 sesiones de inmunoadsorción previas al trasplante renal y el 57,1% se complementaron 2 sesiones posteriores. El tratamiento concomitante fue el protocolizado con Rituximab e inmunoglobulinas, requiriendo el 57,1% la realización de recambios plasmáticos. En el segundo caso, realizaron una media de 5,9±2 sesiones de inmunoadsorción. El tratamiento concomitante fue el mismo y el 27,3% realizaron recambios plasmáticos. Conclusiones: El trasplante renal de donante vivo ABOi tras la desensibilización fue posible en el 100% de los pacientes. El 72,7% de los pacientes tratados para el rechazo mediado por anticuerpos mantienen actualmente la funcionalidad del injerto

Introduction: The non-selective immunoadsorption treatment was introduced in our hospital hemodialysis unit with the aim of allowing desensitization prior to a kidney transplant with blood group incompatibility and the treatment of antibody-mediated rejection. Aim: To analyze the results of the non-selective immunoadsorption technique in a hospital hemodialysis unit. Material and methods: Retrospective descriptive study of the first 18 patients treated in our center with non-selective immunoadsorption (years 2012-2017) in the indications for ABOi transplant conditioning and treatment of humoral rejection. Results: During a period of 5 years, 128 non-selective immunoadsorption sessions were analyzed. 38.9% (n= 7) of cases for desensitization prior to renal transplantation with incompatibility of blood group and 61.1% (n=11) remaining for the treatment of antibody-mediated rejection. In the first case, an average of 8±0.6 sessions of immunoadsorption prior to kidney transplantation were performed and 57.1% were complemented by 2 subsequent sessions. The concomitant treatment was protocolled with rituximab and immunoglobulins, 57.1% requiring plasma exchanges. In the second case, an average of 5.9±2 immunoadsorption sessions were carried out. The concomitant treatment was the same and 27.3% performed plasma exchanges. Conclusions: Kidney transplantation from ABOi living donor after desensitization was possible in 100% of patients. 72.7% of patients treated for antibody-mediated rejection currently maintain graft functionality

How to implement immunoadsorption in a polyvalent dialysis unit: a review.

BACKGROUND: Many kidney-transplant candidates have anti-HLA alloantibodies (HLAi): these make transplantation difficult, even from a living kidney (LK) donor, because of the presence of donor-specific anti-HLA alloantibodies. Due to the shortage of deceased kidney donors, the number of LK transplants is increasing, but is potentially limited by ABO incompatibility (ABOi). OBJECTIVES: To make ABOi and/or HLAi patients suitable for kidney transplantation they need to be desensitised: this strategy is mainly based on rituximab therapy combined with either plasmapheresis (PP) or immunoadsorption (IA). IA can be more efficient than PP because greater plasma volumes can be treated within a single session than a PP session (>4 vs. 1.5-2). IA can be specific (ABOi setting) or non-specific (HLAi). DESIGN: We describe how we designed and implemented a desensitisation programme based on IA. This was started in the first trimester of 2010 within the Acute Polyvalent Haemodialysis and Apheresis Unit in Toulouse University Hospital, France. So far, we have performed >200 IA sessions with good results. RESULTS: The IA sessions were associated with a net body-weight gain of ∼1 kg. Normally, IA is performed first and then haemodialysis on the same or next day; however, we have been able to, for the first time, couple IA with haemodialysis. Moreover, we can now carry out this procedure 24 hours a day, seven days a week. CONCLUSION: This procedure has improved patient care and reduced costs. The IA desensitisation programme has enabled successful transplantation in 24 patients to date.