Double-Filtration Plasmapheresis Plus Low-Dose Anti-thymocyte Globulin and Tacrolimus in Asian Living-Donor Kidney Transplantation With Donor-Specific Anti-HLA Antibody

Kantachuvesiri, Surasak; Ingsathit, Atiporn; Thammanichanond, D.; Choochaeam, Kunvadee; Sra-ium, Supasil; Kitiyakara, Chagriya; Nongnuch, Arkom; Sakulchairungrueng, Bundit; Worawichawong, Suchin

doi:10.1016/j.transproceed.2020.08.019

Cited by 3 publications

(2 citation statements)

References 17 publications

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“…It has long been recognized that immunosuppressant pharmacokinetics exhibit ethnicity-specific differences in bioavailability and dose-dependent systemic exposure. Recently, several studies reported a higher incidence of infectious complications in Asian kidney recipients with ATG induction which is the main reason why a physician is reluctant to use ATG as induction regimen [15][16][17]. Therefore, it is necessary to understand clinical outcomes and adverse events according to the dose of ATG in Asian patients.…”

Section: Introductionmentioning

confidence: 99%

A prospective, randomized, non-blinded, non-inferiority pilot study to assess the effect of low-dose anti-thymocyte globulin with low-dose tacrolimus and early steroid withdrawal on clinical outcomes in non-sensitized living-donor kidney recipients

Ko,

Wee,

Shin

et al. 2023

PLoS ONE

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Background The optimal dose of anti-thymocyte globulin (ATG) as an induction regimen in Asian living-donor kidney recipients is unclear. Methods This is a pilot study in which 36 consecutive patients undergoing living-donor kidney transplantation were randomly assigned to receive either 4.5 mg/kg (n = 19) or 6.0 mg/kg (n = 17) of ATG; all patients had corticosteroid withdrawal within 7 days. The primary end point was a composite of biopsy-proven acute rejection, de novo donor-specific antibody formation, and graft failure. Results At 12 months post-transplant, biopsy-proven acute rejection was more common in the ATG4.5 group (21.1%) than in the ATG6.0 group (0%)(P = .048). Importantly, the rate of the composite end point was significantly higher in the ATG4.5 group (36.8% vs 0%)(P = .006). There were significant differences in neither the renal function nor adverse events between the two groups. One case of death-censored graft failure occurred in the ATG4.5 group and no mortality was observed overall. Compared with pre-transplantation, T cells, natural killer (NK) cells, and natural killer T (NKT) cells were significantly decreased in the first week post-transplantation except for B cells. Although T and NKT cells in both groups and NK cells in the ATG4.5 group had recovered to the pre-transplant levels, NK cells in the ATG6.0 group remained suppressed until six months post-transplant. Conclusions Compared with ATG 6.0 mg/kg, ATG 4.5 mg/kg with early corticosteroid withdrawal and low dose maintenance regimen was associated with higher rates of acute rejection in non-sensitized Asian living-donor kidney recipients. Trial registration ClinicalTrials.gov: NCT02447822.

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Section: Introductionmentioning

confidence: 99%

A prospective, randomized, non-blinded, non-inferiority pilot study to assess the effect of low-dose anti-thymocyte globulin with low-dose tacrolimus and early steroid withdrawal on clinical outcomes in non-sensitized living-donor kidney recipients

Ko,

Wee,

Shin

et al. 2023

PLoS ONE

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“…DFPP is used for the treatment of various pathologies, depending on the target substance to be eliminated (immunoglobulins, LDL‐cholesterol or fibrinogen and clotting factors in order to improve blood rheology and tissue perfusion) 1‐10 …”

Section: Introductionmentioning

confidence: 99%

How to improve clotting factors depletion in double‐filtration plasmapheresis

et al. 2021

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Background Double‐filtration plasmapheresis (DFPP), a selective therapeutic apheresis, can deplete pathogenic antibodies/substances, but also important coagulation factors. Aim To determine if the use of a separator filter with different characteristics (CascadefloEC‐50 W) as compared to the reference filter (PlasmafloOP‐08 W) is as efficient in terms of immunoglobulin loss, but can reduce coagulation factor losses and have similar tolerability. Patients/Methods This is a single‐center prospective study including 14 patients divided into two groups (7 each): that is, group1 = CascadefloEC‐50 W and group2 = PlasmafloOP‐08 W. We measured immunoglobulins, lipid profiles, blood‐cell counts, hemostasis (prothrombin time, activated partial thromboplastin time), coagulation factors, and natural anticoagulants at before and after the first DFPP‐session. Results In group 1, the loss of coagulation factors was significantly reduced as compared to group 2 for proteins with a molecular weight of >150 kDa: there was, respectively, an average decrease of 70% vs 31% for fibrinogen (P = 0.004), 66% vs 21% for factor V (P = 2.16e−07), 60% vs 32% for factor XI (P = 6.96e−06), 75% vs 17% for XIII‐antigen (P = 0.0002), and 47% vs 0% for VWF‐antigen(P = 0.02). The decrease in post‐session IgG was, on average, 45% in group 1 and 50% in group 2 (P = 0.13). Those results remained significant even when adjusted to the treated‐plasma volume and the pre‐DFPP factor values. Conclusion DFPP, using a CascadefloEC‐50W as a first‐filter, reduces efficiently IgGs similarly to PlasmafloOP‐08W but spares clotting factors.

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Double-Filtration Plasmapheresis Plus Low-Dose Anti-thymocyte Globulin and Tacrolimus in Asian Living-Donor Kidney Transplantation With Donor-Specific Anti-HLA Antibody

Cited by 3 publications

References 17 publications

A prospective, randomized, non-blinded, non-inferiority pilot study to assess the effect of low-dose anti-thymocyte globulin with low-dose tacrolimus and early steroid withdrawal on clinical outcomes in non-sensitized living-donor kidney recipients

A prospective, randomized, non-blinded, non-inferiority pilot study to assess the effect of low-dose anti-thymocyte globulin with low-dose tacrolimus and early steroid withdrawal on clinical outcomes in non-sensitized living-donor kidney recipients

How to improve clotting factors depletion in double‐filtration plasmapheresis

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