Reducing Fibrinogen and Factor XIII Using Double-Filtration Plasmapheresis for Antibody-Mediated Rejection: Predictive Models

Jouve, Thomas; Marlu, Raphaël; Malvezzi, Paolo; Seyve, Landry; Maurizi, J.; Carron, Pierre-Louis; Polack, Benoı̂t; Rostaing, Lionel

doi:10.1159/000488928

Cited by 10 publications

(12 citation statements)

References 21 publications

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“…This lower volume of transfused FFP could be related to an insufficient ADAMTS13 supplementation or, on the contrary, be an indicator of a better efficacy with a lower need in FFP transfusion with DFPP. However, the safety of DFPP is discussed with risk of low blood pressure secondary to loss of albumin, hemorrhage with decrease of fibrinogen and hemolysis with filtration needing an extensive knowledge of this technique to limit these potential complications 18–21 …”

Section: Discussionmentioning

confidence: 99%

Use of double filtration plasmapheresis for the treatment of acquired thrombocytopenic thrombotic purpura

et al. 2020

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Double filtration plasmapheresis (DFPP) could be an alternative method to simple plasma exchange plasmapheresis in the treatment of acquired thrombotic thrombocytopenic purpura (aTTP). In a retrospective single center case series, we studied clinical presentation, management care, and prognosis of aTTP patients from our academic center treated with DFPP and IV infusion of fresh frozen plasma (FFP) between 2009 and 2018. Nine patients were included for 11 episodes. Median age was 38 years old (IQR 26‐53) with 78% women. Six episodes (55%) required admission to the ICU, four of which required mechanical ventilation. Median FFP volume transfused was 35.2 mL/kg/d of session. Response was complete for nine episodes (82%). Four patients presented an early relapse, two a late relapse. Four patients died: one had an active untreated HCV infection, and two were over 80‐year‐old polymorbid patients. DFPP seems to be an efficient method of therapeutic plasmapheresis in TTP when combined with FFP transfusion and immunosuppressive treatments.

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Section: Discussionmentioning

confidence: 99%

Use of double filtration plasmapheresis for the treatment of acquired thrombocytopenic thrombotic purpura

et al. 2020

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“…18,19 In addition, we have established a model to predict fibrinogen and FXIII depletion after DFPP sessions and this may help clinicians supplement fibrinogen and/or FXIII where appropriate. 20 Hanafusa et al studied ABOi kidney-transplant candidates and assessed the effect on factor XIII of DFPP or plasmaexchange sessions (where substitution was based on fresh frozen plasma). They reported that depletion of factor XIII was minimal with plasma exchange, whereas it was huge with DFPP.…”

Section: Discussionmentioning

confidence: 99%

“…However, studies have shown that multiple DFPP sessions are associated with huge and long‐lasting factor XIII depletion 18,19 . In addition, we have established a model to predict fibrinogen and FXIII depletion after DFPP sessions and this may help clinicians supplement fibrinogen and/or FXIII where appropriate 20 . Hanafusa et al studied ABOi kidney‐transplant candidates and assessed the effect on factor XIII of DFPP or plasma‐exchange sessions (where substitution was based on fresh frozen plasma).…”

Section: Discussionmentioning

confidence: 99%

Isoagglutinin removal by plasma centrifugation or filtration (single or double): A prospective study in a single center

Bennani

Noble

Chevallier

et al. 2020

J of Clinical Apheresis

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Introduction: ABO-incompatible (ABOi) kidney transplantation, a wellestablished procedure, has good long-term results provided pretransplant desensitization that includes immunosuppression and apheresis. Objective: To compare, within the first pretransplant apheresis session given to 29 ABOi kidney-transplant candidates, the effect on isoagglutinin titers (both IgG and IgM isotypes) of three modalities: centrifugation therapeutic plasmapheresis (cTP; n = 10), filtration TP (fTP; n = 9), and double-filtration plasmapheresis (DFPP; n = 10). Results: The three groups were comparable according to baseline demographics. Treated plasma volumes were similar across the three groups, that is, 4111 ± 403 mL (cTP), 3861 ± 282 mL (fTP), and 3699 ± 820 mL (DFPP): that is, 54 ± 7, 53 ± 7, and 53 ± 10 mL/kg respectively. One session of centrifugation or filtration TP reduced IgG anti-A/anti-B isoagglutinin titer by~4, whereas one DFPP session reduced it by~2. One session of cTP reduced IgM anti-A isoagglutinin titer by a little less than 4, whereas fTP and DFPP sessions reduced it by~3. There were no statistical differences across the three groups regarding isoagglutinin rebound (IgG and IgM). However, isoagglutinin IgG rebound was >4 dilutions for anti-B titers compared with~2 dilutions for anti-A titers. The median decreases in IgG level were −3.9 g/L (DFPP), −5.9 g/L (cTP), and − 6.06 g/L (fTP) (p = ns). Median fibrinogen depletions were~60% (fTP), 64% (DFPP), and 76% (cTP). Conclusions: Isoagglutinin depletions within the first apheresis session were similar across cTP, fTP, and DFPP: this was numerically lower for DFPP.

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“…Another apheresis technique, double‐filtration plasmapheresis (DFPP), can treat larger volumes of plasma but can also significantly decrease clotting factors 7 . DFPP can be used in the setting of antibody‐mediated rejection after kidney transplantation, 7 for desensitization before ABO‐incompatible kidney transplantation, 8 but also in the setting of autoimmune disease. Recently, Cheng et al reported on a cohort of 42 patients with anti‐neutrophil cytoplasmic antibody‐associated vasculitis and renal involvement.…”

Section: Introductionmentioning

confidence: 99%

Comparison of three modalities of plasmapheresis on coagulation: Centrifugal, single‐membrane filtration, and double‐filtration plasmapheresis

Marlu

Bennani

Seyve

et al. 2021

J of Clinical Apheresis

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Background Plasmapheresis can deplete pathogenic antibodies and allow ABO‐ and/or HLA‐incompatible transplantation. Aim To determine the impacts of three modalities of plasmapheresis (centrifugal plasmapheresis [cTPE], single‐filtration plasmapheresis [mTPE], double‐filtration plasmapheresis [DFPP]) on hemostasis parameters and thrombin generation. Materials/Methods Prospective, comparative study on 21 patients that received three modalities of plasmapheresis (7 patients/group). Hemostasis (prothrombin time [PT], activated partial thromboplastin time [aPTT], procoagulant factors and natural anticoagulants) were measured before and after the first plasmapheresis session. Thrombin generation was also assessed in platelet‐poor plasma using an STA‐Genesia (Stago) analyzer and Thromboscreen reagents (Stago) in 4‐5 patients from each group. Results Both cTPE and mTPE resulted in high decreases in proteins, whatever their molecular weights. Median post/pre ratios were 0.27 to 0.55 for cTPE for most proteins (except FVIII [0.64] and VWF [0.57]). Median post/pre‐ratios of mTPE were 0.28 to 0.56 for all proteins. DFPP decreased high‐molecular‐weight proteins (fibrinogen, FV, FVIII, FXI, VWF) and proteins strongly bound to large molecules (protein SandTFPI). Median post/pre ratios with cTPE and mTPE were similar to DFPP for fibrinogen and FXIII. Regarding thrombin generation, cTPE and mTPE did not significantly modify endogenous thrombin potential (ETP) and DFPP induced a slight decrease in ETP (median post/pre ratio at 0.73) in the absence of thrombomodulin. ETP inhibition by thrombomodulin was decreased for all procedures. Conclusions DFPP depleted high molecular‐weight proteins in contrast to cTPE and mTPE, which significantly decreased all proteins. Regarding thrombin generation, depletion of procoagulant factors was counterbalanced by a decrease in some natural anticoagulants whatever plasmapheresis method used; with all methods, fibrinogen and FXIII were highly depleted.

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Reducing Fibrinogen and Factor XIII Using Double-Filtration Plasmapheresis for Antibody-Mediated Rejection: Predictive Models

Cited by 10 publications

References 21 publications

Use of double filtration plasmapheresis for the treatment of acquired thrombocytopenic thrombotic purpura

Use of double filtration plasmapheresis for the treatment of acquired thrombocytopenic thrombotic purpura

Isoagglutinin removal by plasma centrifugation or filtration (single or double): A prospective study in a single center

Comparison of three modalities of plasmapheresis on coagulation: Centrifugal, single‐membrane filtration, and double‐filtration plasmapheresis

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