Therapeutic apheresis in kidney transplantation: Emerging trends.

Autor: Okwuonu CG; Division of Nephrology, University of Virginia Health, Charlottesville, Virginia, USA.; Federal Medical Centre, Umuahia, Nigeria., Shah M; Division of Nephrology, University of Virginia Health, Charlottesville, Virginia, USA., Rafique I; Division of Nephrology, University of Virginia Health, Charlottesville, Virginia, USA., Abdelrazeq AS; Division of Nephrology, University of Virginia Health, Charlottesville, Virginia, USA., Kamal J; Division of Nephrology, University of Virginia Health, Charlottesville, Virginia, USA., Rao S; Division of Nephrology, University of Virginia Health, Charlottesville, Virginia, USA., Abiodun Balogun R; Division of Nephrology, University of Virginia Health, Charlottesville, Virginia, USA.
Jazyk: angličtina
Zdroj: Journal of clinical apheresis [J Clin Apher] 2024 Jun; Vol. 39 (3), pp. e22119.
DOI: 10.1002/jca.22119
Abstrakt: Introduction: The use of therapeutic apheresis (TA) either as stand-alone or adjunctive treatment in kidney transplantation has increased over the years to become a leading indication. This study shows recent trends in indications for TA related to kidney transplantation, adverse events, and patient outcome in this cohort.
Methods: This is a retrospective cohort review of adults who received TA for kidney transplant-related indications from January 1, 2017, to December 31, 2022, at the University of Virginia Medical Centre, Charlottesville, VA, USA. Data extracted include basic demographics, indication for apheresis, number of procedures, procedure characteristics, procedure-related adverse events (complications), and serum ionized calcium and serum creatinine. Data were analyzed using statistical package for social sciences (SPSS 2022 IBM Inc).
Results: Data from a total of 131 patients who received 860 TA procedures were analyzed. Indications for TA were antibody-mediated rejection (65.5%), recurrent focal segmental glomerulosclerosis (15%), thrombotic microangiopathy (5%), desensitization for ABO incompatibility (4.5%) and for HLA-incompatibility (4.5%), and recurrent IgA nephropathy (1%). Some adverse events were encountered in 16.7% of the procedures and include hypocalcemia (7%), vascular access malfunction (0.7%), hypotension (1.2%), arrhythmia (0.6%), and depletion coagulopathy (0.6%). The overall case mortality rate was 8.4% over the 6-year period. There was one death recorded on machine during TA resulting in a procedure-mortality rate of 0.12%.
Conclusion: Antibody-mediated rejection was the most common indication for TA related to kidney transplantation. Adverse events were minor and patient survival over the time was within usual limits.
(© 2024 The Authors. Journal of Clinical Apheresis published by Wiley Periodicals LLC.)
Databáze: MEDLINE
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