Immunoadsorption and Hemodialysis as a Tandem Procedure: A Single-Center Experience of More than 60 Procedures
| Autor: | Eric Faubel, Martine Hermelin, Sébastien Maggioni, Nassim Kamar, Asma Allal, Lionel Rostaing |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Biomedical Engineering Medicine (miscellaneous) Bioengineering Single Center Mycophenolic acid Biomaterials Young Adult Renal Dialysis Living Donors medicine Humans Immunoadsorption Immunosorbent Techniques Kidney transplantation Aged Desensitization (medicine) business.industry Plasmapheresis General Medicine Middle Aged medicine.disease Kidney Transplantation Surgery Kidney Failure Chronic Female Rituximab Hemodialysis business Immunosuppressive Agents medicine.drug |
| Zdroj: | The International Journal of Artificial Organs. 38:304-310 |
| ISSN: | 1724-6040 0391-3988 |
| DOI: | 10.5301/ijao.5000420 |
| Popis: | PurposeWe have designed a desensitization program that gives good results and is cost effective for kidney-transplant patients who have a potential living donor, who are ABO incompatible (ABOi), and who may or may not have donor-specific alloantibodies (DSAs).MethodsDesensitization at pretransplant is based on immunosuppressants (such as rituximab, tacrolimus, and mycophenolic acid) and apheresis to retrieve potentially detrimental isoagglutinins and DSAs from blood. In 2011, we implemented immunoadsorption (IA) instead of plasmapheresis in our center as part of the desensitization protocol. Because IA is very tedious and time-consuming, we decided to perform IA and hemodialysis (HD) in tandem instead of performing these methods sequentially. Herein, we report on more than 100 of these tandem procedures and compare the results to those obtained when IA was performed before a HD session.ResultsThe tandem process resulted in nursing time being cut by half: from almost 10h30 min/patient to 6 h/patient. When IA was performed alone, body-weight gain was 1 kg (range 0 to 1.75) and the median volume of plasma treated per session was 6500 mL (range 4500 to 10 600). Conversely, during a tandem IA + HD session, the net median weight gain was −1.5 kg (range −4.1 to 0) and the median volume of plasma treated per session was 5000 mL (range 4000 to 8600). In addition, the tandem procedure was as well tolerated as that for IA followed by HD.ConclusionsTandem IA plus HD is a safe and cost-effective procedure. |
| Databáze: | OpenAIRE |
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