Effect of immunoadsorption alone or combined with membrane filtration on hemostasis parameters

Abstract

Introduction ABO‐ or HLA‐incompatible kidney transplantation is possible thanks to pretransplant antibody‐depletion achieved by extracorporeal‐treatment modalities. These methods induce depletion of some plasma proteins and may also impact on proteins involved in hemostasis. Methods To determine the impact of one session of immunoadsorption (IA) alone or combined with membrane filtration (MF) on clotting factors and natural anticoagulants, we performed a prospective, observational study on 13 patients waiting for HLA‐/ABO‐incompatible kidney transplants. Plasma hemostasis parameters were measured before and immediately after a first session of IA alone in six patients and of IA + MF in seven patients. Results IA alone induced depletion of fibrinogen and factor XIII (FXIII) whereas IA + MF caused greater depletion of all high‐molecular‐weight hemostatic proteins (fibrinogen, FV, FVIII, FXI, FXIII, von‐Willebrand factor [VWF]). After an IA session, median reductions were 30% for fibrinogen and 43% for FXIII compared to baseline values. After a session of IA + MF, median decreases were 70% for fibrinogen, 54% for FV, 56% for FVIII, 37% for FXI, 78% for FXIII, and 62% for VWF. Noticeably, levels of low‐molecular‐weight factors (<100 kDa) were far less decreased than high‐molecular‐weight proteins with IA + MF, except for protein S and the tissue factor pathway inhibitor, which are known to be partially physiologically bound to high‐molecular‐weight molecules. Conclusions IA and IA + MF induced significant depletion of some proteins implicated in the hemostatic process; however, IA + MF resulted in stronger modifications to hemostasis parameters than IA alone. This may have potential clinical implications regarding bleeding risk, and particularly depletion of fibrinogen and FXIII.

Fibrinogen reconstitution after therapeutic apheresis: Comparison of double‐filtration plasmapheresis, plasma exchange, and immunoadsorption

“…Fibrinogen depletion was in line with our previous investigations, 16 showing a 30% depletion using IA with selective adsorbers. Using filtration with a LDL‐apheresis filter (IA + plasma filtration) increased this depletion, there again in line with the previous data.…”

Is There a Place for Apheresis in the Management of Idiopathic Membranous Nephropathy? A Report of Three Cases and Literature Review

“…Vascular access necessitated the insertion of a central venous jugular catheter, which was removed upon the completion of the apheresis therapy. Extracorporeal anticoagulation was achieved through regional anticoagulation using citrate, with calcium reinjection into the returning venous line [ 14 ].…”

Desensitization in Crossmatch-positive Kidney Transplant Candidates

“…Moreover, IA alone induces slight depletion of fibrinogen and factor (F) XIII, whereas the addition of membrane filtration causes greater depletion of all high-molecular-weight hemostatic proteins (fibrinogen, FV, FVIII, FXI, FXIII, vonWillebrand factor). 60 However, fibrinogen depletion is lower with IA as compared with PP or DFPP, which is important to consider before KT. 61,62 In 2021, Noble et al 63 assessed the performance and tolerance of the different apheresis techniques (IA, DFPP, and PP) to remove HLA antibodies in highly sensitized patients.…”