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

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70 Scopus citations

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 1 2008

ASJC Scopus subject areas

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

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    Akalin, E., Dinavahi, R., Friedlander, R., Ames, S., de Boccardo, G., Sehgal, V., Schröppel, B., Bhaskaran, M., Lerner, S., Fotino, M., Murphy, B., & Bromberg, J. S. (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, 3(4), 1160-1167. https://doi.org/10.2215/CJN.05321107