Addition of plasmapheresis decreases the incidence of acute antibody-mediated rejection in sensitized patients with strong donor-specific antibodies

Enver Akalin, Rajani Dinavahi, Rex Friedlander, Scott Ames, Graciela de Boccardo, Vinita Sehgal, Bernd Schröppel, Madhu Bhaskaran, Susan Lerner, Marileno Fotino, Barbara Murphy, Jonathan S. Bromberg

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

Background and objectives: The objective of this study was to investigate the effects of desensitization protocols using intravenous Ig with or without plasmapheresis in patients with donor-specific anti-HLA antibodies on prevention of antibody-mediated rejection and downregulation of donor-specific antibodies. Design, setting, participants, & measurements: Thirty-five complement-dependent cytotoxicity T cell cross-match-negative but complement-dependent cytotoxicity B cell and/or flow cytometry cross-match-positive kidney transplant recipients were treated with high-dosage intravenous Ig plus Thymoglobulin induction treatment. Donor-specific antibody strength was stratified as strong, medium, or weak by Luminex flow beads. Group 1 patients had weak/moderate and group 2 strong donor-specific antibodies Results: Whereas no group 1 patients had acute rejection, 66% of group 2 had acute rejection (44% antibody-mediated rejection, 22% cellular rejection). The protocol was then changed to the addition of peritransplantation plasmapheresis to patients with strong donor-specific antibodies (group 3). This change resulted in a dramatic decrease in the acute rejection rate to 7%. During a median 18 mo of follow-up, patient survival was 100, 100, and 93% and graft survival was 100, 78, and 86% in groups 1, 2, and 3, respectively. During follow-up, 17 (52%) patients lost donor-specific antibodies completely, and 10 (30%) lost some of donor-specific antibodies and/or decreased the strength of existing donor-specific antibodies. Conclusions: These results indicated that in patients with strong donor-specific antibodies, the addition of plasmapheresis to high-dosage intravenous Ig decreases the incidence of acute rejection. The majority of the patients, whether they received intravenous Ig alone or with plasmapheresis, lost their donor-specific antibodies during follow-up.

Original languageEnglish (US)
Pages (from-to)1160-1167
Number of pages8
JournalClinical Journal of the American Society of Nephrology
Volume3
Issue number4
DOIs
StatePublished - Jul 2008
Externally publishedYes

Fingerprint

Plasmapheresis
Tissue Donors
Antibodies
Incidence
Graft Survival
Anti-Idiotypic Antibodies
Flow Cytometry
B-Lymphocytes
Down-Regulation
T-Lymphocytes
Kidney

ASJC Scopus subject areas

  • Nephrology
  • Transplantation
  • Epidemiology
  • Critical Care and Intensive Care Medicine

Cite this

Addition of plasmapheresis decreases the incidence of acute antibody-mediated rejection in sensitized patients with strong donor-specific antibodies. / Akalin, Enver; Dinavahi, Rajani; Friedlander, Rex; Ames, Scott; de Boccardo, Graciela; Sehgal, Vinita; Schröppel, Bernd; Bhaskaran, Madhu; Lerner, Susan; Fotino, Marileno; Murphy, Barbara; Bromberg, Jonathan S.

In: Clinical Journal of the American Society of Nephrology, Vol. 3, No. 4, 07.2008, p. 1160-1167.

Research output: Contribution to journalArticle

Akalin, E, Dinavahi, R, Friedlander, R, Ames, S, de Boccardo, G, Sehgal, V, Schröppel, B, Bhaskaran, M, Lerner, S, Fotino, M, Murphy, B & Bromberg, JS 2008, 'Addition of plasmapheresis decreases the incidence of acute antibody-mediated rejection in sensitized patients with strong donor-specific antibodies', Clinical Journal of the American Society of Nephrology, vol. 3, no. 4, pp. 1160-1167. https://doi.org/10.2215/CJN.05321107
Akalin, Enver ; Dinavahi, Rajani ; Friedlander, Rex ; Ames, Scott ; de Boccardo, Graciela ; Sehgal, Vinita ; Schröppel, Bernd ; Bhaskaran, Madhu ; Lerner, Susan ; Fotino, Marileno ; Murphy, Barbara ; Bromberg, Jonathan S. / Addition of plasmapheresis decreases the incidence of acute antibody-mediated rejection in sensitized patients with strong donor-specific antibodies. In: Clinical Journal of the American Society of Nephrology. 2008 ; Vol. 3, No. 4. pp. 1160-1167.
@article{f4c53d6a3d874b648a56874aec71f5a1,
title = "Addition of plasmapheresis decreases the incidence of acute antibody-mediated rejection in sensitized patients with strong donor-specific antibodies",
abstract = "Background and objectives: The objective of this study was to investigate the effects of desensitization protocols using intravenous Ig with or without plasmapheresis in patients with donor-specific anti-HLA antibodies on prevention of antibody-mediated rejection and downregulation of donor-specific antibodies. Design, setting, participants, & measurements: Thirty-five complement-dependent cytotoxicity T cell cross-match-negative but complement-dependent cytotoxicity B cell and/or flow cytometry cross-match-positive kidney transplant recipients were treated with high-dosage intravenous Ig plus Thymoglobulin induction treatment. Donor-specific antibody strength was stratified as strong, medium, or weak by Luminex flow beads. Group 1 patients had weak/moderate and group 2 strong donor-specific antibodies Results: Whereas no group 1 patients had acute rejection, 66{\%} of group 2 had acute rejection (44{\%} antibody-mediated rejection, 22{\%} cellular rejection). The protocol was then changed to the addition of peritransplantation plasmapheresis to patients with strong donor-specific antibodies (group 3). This change resulted in a dramatic decrease in the acute rejection rate to 7{\%}. During a median 18 mo of follow-up, patient survival was 100, 100, and 93{\%} and graft survival was 100, 78, and 86{\%} in groups 1, 2, and 3, respectively. During follow-up, 17 (52{\%}) patients lost donor-specific antibodies completely, and 10 (30{\%}) lost some of donor-specific antibodies and/or decreased the strength of existing donor-specific antibodies. Conclusions: These results indicated that in patients with strong donor-specific antibodies, the addition of plasmapheresis to high-dosage intravenous Ig decreases the incidence of acute rejection. The majority of the patients, whether they received intravenous Ig alone or with plasmapheresis, lost their donor-specific antibodies during follow-up.",
author = "Enver Akalin and Rajani Dinavahi and Rex Friedlander and Scott Ames and {de Boccardo}, Graciela and Vinita Sehgal and Bernd Schr{\"o}ppel and Madhu Bhaskaran and Susan Lerner and Marileno Fotino and Barbara Murphy and Bromberg, {Jonathan S.}",
year = "2008",
month = "7",
doi = "10.2215/CJN.05321107",
language = "English (US)",
volume = "3",
pages = "1160--1167",
journal = "Clinical Journal of the American Society of Nephrology",
issn = "1555-9041",
publisher = "American Society of Nephrology",
number = "4",

}

TY - JOUR

T1 - Addition of plasmapheresis decreases the incidence of acute antibody-mediated rejection in sensitized patients with strong donor-specific antibodies

AU - Akalin, Enver

AU - Dinavahi, Rajani

AU - Friedlander, Rex

AU - Ames, Scott

AU - de Boccardo, Graciela

AU - Sehgal, Vinita

AU - Schröppel, Bernd

AU - Bhaskaran, Madhu

AU - Lerner, Susan

AU - Fotino, Marileno

AU - Murphy, Barbara

AU - Bromberg, Jonathan S.

PY - 2008/7

Y1 - 2008/7

N2 - Background and objectives: The objective of this study was to investigate the effects of desensitization protocols using intravenous Ig with or without plasmapheresis in patients with donor-specific anti-HLA antibodies on prevention of antibody-mediated rejection and downregulation of donor-specific antibodies. Design, setting, participants, & measurements: Thirty-five complement-dependent cytotoxicity T cell cross-match-negative but complement-dependent cytotoxicity B cell and/or flow cytometry cross-match-positive kidney transplant recipients were treated with high-dosage intravenous Ig plus Thymoglobulin induction treatment. Donor-specific antibody strength was stratified as strong, medium, or weak by Luminex flow beads. Group 1 patients had weak/moderate and group 2 strong donor-specific antibodies Results: Whereas no group 1 patients had acute rejection, 66% of group 2 had acute rejection (44% antibody-mediated rejection, 22% cellular rejection). The protocol was then changed to the addition of peritransplantation plasmapheresis to patients with strong donor-specific antibodies (group 3). This change resulted in a dramatic decrease in the acute rejection rate to 7%. During a median 18 mo of follow-up, patient survival was 100, 100, and 93% and graft survival was 100, 78, and 86% in groups 1, 2, and 3, respectively. During follow-up, 17 (52%) patients lost donor-specific antibodies completely, and 10 (30%) lost some of donor-specific antibodies and/or decreased the strength of existing donor-specific antibodies. Conclusions: These results indicated that in patients with strong donor-specific antibodies, the addition of plasmapheresis to high-dosage intravenous Ig decreases the incidence of acute rejection. The majority of the patients, whether they received intravenous Ig alone or with plasmapheresis, lost their donor-specific antibodies during follow-up.

AB - Background and objectives: The objective of this study was to investigate the effects of desensitization protocols using intravenous Ig with or without plasmapheresis in patients with donor-specific anti-HLA antibodies on prevention of antibody-mediated rejection and downregulation of donor-specific antibodies. Design, setting, participants, & measurements: Thirty-five complement-dependent cytotoxicity T cell cross-match-negative but complement-dependent cytotoxicity B cell and/or flow cytometry cross-match-positive kidney transplant recipients were treated with high-dosage intravenous Ig plus Thymoglobulin induction treatment. Donor-specific antibody strength was stratified as strong, medium, or weak by Luminex flow beads. Group 1 patients had weak/moderate and group 2 strong donor-specific antibodies Results: Whereas no group 1 patients had acute rejection, 66% of group 2 had acute rejection (44% antibody-mediated rejection, 22% cellular rejection). The protocol was then changed to the addition of peritransplantation plasmapheresis to patients with strong donor-specific antibodies (group 3). This change resulted in a dramatic decrease in the acute rejection rate to 7%. During a median 18 mo of follow-up, patient survival was 100, 100, and 93% and graft survival was 100, 78, and 86% in groups 1, 2, and 3, respectively. During follow-up, 17 (52%) patients lost donor-specific antibodies completely, and 10 (30%) lost some of donor-specific antibodies and/or decreased the strength of existing donor-specific antibodies. Conclusions: These results indicated that in patients with strong donor-specific antibodies, the addition of plasmapheresis to high-dosage intravenous Ig decreases the incidence of acute rejection. The majority of the patients, whether they received intravenous Ig alone or with plasmapheresis, lost their donor-specific antibodies during follow-up.

UR - http://www.scopus.com/inward/record.url?scp=46249133715&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=46249133715&partnerID=8YFLogxK

U2 - 10.2215/CJN.05321107

DO - 10.2215/CJN.05321107

M3 - Article

VL - 3

SP - 1160

EP - 1167

JO - Clinical Journal of the American Society of Nephrology

JF - Clinical Journal of the American Society of Nephrology

SN - 1555-9041

IS - 4

ER -