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Kalenderoğlu MD, Çomak E, Aksoy GK, Bilge U, Küpesiz OA, Koyun M, Akman S. Therapeutic apheresis: is it safe in children with kidney disease? Pediatr Nephrol 2024; 39:2451-2457. [PMID: 38502222 PMCID: PMC11199252 DOI: 10.1007/s00467-024-06346-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/23/2024] [Accepted: 02/23/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Therapeutic apheresis (TA) is already used to treat various diseases in the field of nephrology. The aim of this study was to evaluate the frequency and types of complications that occur during TA in children with kidney disease. METHODS Records of children (≤ 18 years) who underwent TA between 2007 and 2022 were retrospectively reviewed. Children with missing data and those with a diagnosis of nonnephrological disease were excluded. RESULTS A total of 1214 TA sessions, including 1147 therapeutic plasma exchange (TPE) sessions and 67 immunoadsorption (IA) sessions, were performed on the 108 patients enrolled in the study. Forty-seven percent of the patients were male, and the mean age was 12.22 ± 4.47 years. Posttransplant antibody-mediated rejection (64.8%) and hemolytic uremic syndrome (14.8%) were the most common diagnoses indicating TA. Overall, 17 different complications occurred in 58 sessions (4.8%), and 53 sessions (4.6%) were not completed because of these complications. The distribution of complications among the patients was as follows: 41.4% had technical complications, 25.9% had allergic complications, and 32.7% had others. The most common technical complication was insufficient flow (37.5%). The incidence of complications was greater in patients aged 3-6 years than in patients in the other age groups (p = 0.031). The primary disease, type of vascular access, and rate of fresh frozen plasma/albumin use were similar between patients with and without complications (p values of 0.359 and 0.125 and 0.118, respectively). CONCLUSIONS Our study showed that complications occurred in only 4.8% of TA sessions. The most common complication was technical problems.
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Affiliation(s)
| | - Elif Çomak
- Department of Pediatric Nephrology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Gülşah Kaya Aksoy
- Department of Pediatric Nephrology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Uğur Bilge
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Osman Alphan Küpesiz
- Pediatric Hematology and Oncology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Mustafa Koyun
- Department of Pediatric Nephrology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Sema Akman
- Department of Pediatric Nephrology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
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Rana DS, Bhalla AK, Gupta A, Malik M, Gupta A. Enhancing Success in the ABO-Incompatible Kidney Transplantation: A Case Report. Cureus 2024; 16:e62350. [PMID: 39006667 PMCID: PMC11246545 DOI: 10.7759/cureus.62350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2024] [Indexed: 07/16/2024] Open
Abstract
Kidney transplantation is the preferred treatment for end-stage renal disease (ESRD); however, ABO incompatibility (ABOi) poses challenges due to increased graft rejection risk. Desensitization strategies, including immunoadsorption (IA), aim to overcome ABOi barriers. The objective of this case report was to present the initial findings and patient outcomes of ABOi kidney transplantation (KT) using two different brands of IA columns (Glycosorb® ABO and SECORIM®-ABO) in reducing isoagglutinin titers to the desired target level. We present a case report of a 51-year-old male with ESRD secondary to diabetic kidney disease who underwent desensitization for ABOi KT, involving rituximab administration followed by IA using Glycosorb® and Vitrosorb SECORIM®-ABO columns and plasmapheresis (PP). Glycosorb® ABO column decreased anti-B titers from an initial level of 1:128/1:128 to 1:64/1:64 (target range ≤1:8); however, the titers rebounded to 1:64 following the fourth session of PP. Subsequent use of Vitrosorb SECORIM®-ABO column achieved target titers of 1:4, enabling successful transplantation with satisfactory graft function. Monitoring included anti-B IgG/IgM titer levels post IA columns, IA column reuse, kidney function, and adverse events. The IA columns were well tolerated. Desensitization using IA columns effectively reduced anti-B titers, facilitating successful ABOi KT.
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Affiliation(s)
- D S Rana
- Nephrology, Sir Ganga Ram Hospital, New Delhi, IND
| | - A K Bhalla
- Nephrology, Sir Ganga Ram Hospital, New Delhi, IND
| | | | - Manish Malik
- Nephrology, Sir Ganga Ram Hospital, New Delhi, IND
| | - Anurag Gupta
- Nephrology, Sir Ganga Ram Hospital, New Delhi, IND
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Pavenski K, Bucholz M, Cheatley PL, Krok E, Anderson M, Prasad GR, Qureshi MA, Meliton G, Zaltzman J. The First North American Experience Using Glycosorb Immunoadsorption Columns for Blood Group-Incompatible Kidney Transplantation. Can J Kidney Health Dis 2020; 7:2054358120962586. [PMID: 33101699 PMCID: PMC7549322 DOI: 10.1177/2054358120962586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/12/2020] [Indexed: 01/23/2023] Open
Abstract
Background: Blood group incompatibility (ABOi) is the most common barrier to living donor
kidney transplantation. Options for such recipients include kidney paired
donation (KPD) or desensitization methodology to reduce blood antibody
response. Objective: The objective of this study is to report on the first North America
experience in ABOi living donor kidney transplantation using Glycosorb ABO
immunoadsorption columns. Design: Retrospective observational cohort study. Setting: Renal transplant program at St. Michael’s Hospital, Unity Health Toronto,
University of Toronto. Patients: Twenty-six ABOi living donor transplants from August 2011 through February
2020 were undertaken at our center. Measurements: Renal allograft and patient survival postdesensitization for ABOi living
donor transplants and isohemagglutinin titer reduction. Methods: Preoperative immunosuppressive regimen consisted of a single dose of
Rituximab 375 mg/m2 IV on day −28; tacrolimus, mycophenolic acid,
and prednisone to start on day −7. Immunoadsorption treatments with
Glycosorb A or B columns were performed on day −7 through day −1 based on
anti-A or anti-B titers on Spectra Optia Apheresis System. Immunosuppression
included basiliximab, solumedrol followed by oral prednisone, once-daily
tacrolimus, and mycophenolic acid. The mean follow-up was 53 months (3-96
months). Results: A total of 26 individuals underwent an attempt at desensitization of whom 24
patients underwent immediate transplant. One patient had a rebound in titers
and subsequently was transplanted from a blood group compatible living
donor. A second patient had an unrelated medical issue and desensitization
was discontinued. Five-year patient survival was 96% and death censored
allograft survival was 92%. Posttransplant anti-A or anti-B titers were
monitored daily for the first 7 days posttransplant and every 2 days from
days 7 to 14. There were no acute rejections seen in this cohort of
transplant recipients. Limitations: As our protocol was first initiated as proof of concept, a few recipients had
low initial isohemagglutinin titers. This may have contributed to improved
clinical outcomes. Conclusions: ABO column immunoadsorption with specific columns is a safe and effective
method for ABOi living donor kidney transplantation, and an option when KPD
is less than ideal. Trial not registered as this was a retrospective cohort review.
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Affiliation(s)
- Katerina Pavenski
- St. Michael's Hospital, Unity Health Toronto, University of Toronto, ON, Canada.,Department of Transfusion Medicine, University of Toronto, ON, Canada
| | - Megan Bucholz
- St. Michael's Hospital, Unity Health Toronto, University of Toronto, ON, Canada.,Department of Transfusion Medicine, University of Toronto, ON, Canada
| | - Patti Lou Cheatley
- St. Michael's Hospital, Unity Health Toronto, University of Toronto, ON, Canada.,Department of Transfusion Medicine, University of Toronto, ON, Canada
| | - Elizabeth Krok
- St. Michael's Hospital, Unity Health Toronto, University of Toronto, ON, Canada.,Department of Transfusion Medicine, University of Toronto, ON, Canada
| | - Monique Anderson
- St. Michael's Hospital, Unity Health Toronto, University of Toronto, ON, Canada.,Department of Transfusion Medicine, University of Toronto, ON, Canada
| | - Gv Ramesh Prasad
- St. Michael's Hospital, Unity Health Toronto, University of Toronto, ON, Canada.,Department of Medicine, Division of Nephrology and Transplantation, University of Toronto, ON, Canada
| | | | - Galo Meliton
- St. Michael's Hospital, Unity Health Toronto, University of Toronto, ON, Canada.,Department of Medicine, Division of Nephrology and Transplantation, University of Toronto, ON, Canada
| | - Jeffrey Zaltzman
- St. Michael's Hospital, Unity Health Toronto, University of Toronto, ON, Canada.,Department of Medicine, Division of Nephrology and Transplantation, University of Toronto, ON, Canada
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