Protein A-Based Immunoadsorption Is More Efficient Than Conventional Plasma Exchange to Remove Circulating Anti-HLA Antibodies

Abstract

We retrospectively evaluated the ability of protein-A immunoadsorption (IA) as compared to that of conventional plasma exchanges (PE) in reducing the mean fluorescence intensity (MFI) of anti-HLA antibodies assessed by the single antigen assay in sensitized renal transplant recipients. Change in MFI of 441 anti-HLA antibodies was measured after 1 single session of IA or after 3 consecutive daily PE sessions. While both strategies were able to significantly lower the amount of anti-HLA antibodies, the relative reduction in MFI was higher after IA as compared to PE (-69 vs. -58%, respectively, p = 0.003). This better efficacy of IA was observed despite a lower total volume of treated plasma (105 ± 6 vs. 160 ± 16 ml/kg after IA and after PE, respectively). Our data suggest a higher efficiency of IA over conventional PE sessions to remove anti-HLA antibodies and call for a larger evaluation of IA to confirm its potential added value in desensitization protocols.

Efficacy of plasmapheresis and semi‐selective immunoadsorption for removal of anti‐HLA antibodies

“…We found that the efficacy of anti‐HLA antibody removal after extended apheresis protocol exhibited a linear relationship with initial MFI. Unlike the findings of Maillard et al, 22 but consistent with those of Pinelli et al, 23 other characteristics of anti‐HLA antibodies, such as targeted class or locus, were not independently associated with the efficacy of antibody removal. Several studies have reported that class II antibodies, particularly those directed against HLA‐DQ molecules, were more resistant to ABMR treatments 25‐28 .…”

“…Unfortunately, it is impossible to increase the plasma volume treated in a single PP session because of poor tolerance, in turn due to the loss of important coagulation factors 32 . The previously published data of Maillard et al showed that one IA session achieved results superior to those of 3 PP sessions despite treating smaller volume of plasma, 100 vs 180 mL/kg, respectively 22 . In the present study, we showed that increasing the total volume of treated plasma by using extended rather than short PP protocol was relatively inefficient, while the extended protocol was effective with IA.…”

“…An interesting study by Maillard et al compared the ability of PP and IA to reduce the MFI of anti‐HLA antibodies in kidney recipients 22 . They compared the performance of a single IA session with that of three consecutive daily PP sessions.…”

Protein A immunoadsorption combination with immunosuppressive therapy improves neuropsychiatric systemic lupus erythematosus: A case report

“…Neuropsychiatric systemic lupus erythematosus is associated with a worse prognosis, and brain MRI scan is recommended to evaluate brain lesions inpatients 12 . The most frequent MRI findings are focal lesions in subcortical white matter, cortical atrophy, diffuse cortical gray matter changes, and less brain and corpus callosum volumes in patients with NPSLE 13,14 .…”

Assessing Influence of Solution-focused Nursing for Severe Acute Pancreatitis Patients in Double Filtration Plasmapheresis

“…In some Chinese hospital, DFPP teams have been assembled to manage perioperative DFPP. This approach allows for improved efficiency and reduced time to therapy [4,5]. In addition, the DFPP team typically consists 6 roles, such as transfusion medicine physician, doctor with severe acute pancreatitis, perfusionist, pharmacist, anesthesiologist and critical care nurses [6].…”