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Montagud-Marrahi E, Revuelta I, Cucchiari D, Piñeiro GJ, Ventura-Aguiar P, Lozano M, Cid J, Martorell J, Solé M, Quintana LF, Oppenheimer F, Diekmann F, Poch E, Campistol JM, Blasco M. Successful use of nonantigen-specific immunoadsorption with antihuman Ig-columns in kidney graft antibody-mediated rejection. J Clin Apher 2020; 35:188-199. [PMID: 32219886 DOI: 10.1002/jca.21779] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Nonantigen-specific immunoadsorption (IA) has proven to be effective in acute antibody-mediated rejection (aAMR). However, there is a lack of solid studies evaluating the safety and efficacy of IA with antihuman Ig-columns in aAMR. For chronic-active AMR (cAMR), no studies have evaluated the efficacy of nonantingen-specific IA with antihuman Ig-columns. The purpose of this study was to evaluate the role of nonantigen-specific IA with antihuman Ig-columns in the treatment of both aAMR and cAMR in kidney transplantation. MATERIAL AND METHODS In retrospective and observational study, kidney graft and recipient survival rates were assessed after treatment of aAMR and cAMR with nonantigen-specific IA with Ig-Flex columns (Therasorb) between January 2012 and May 2018. Protocols included nonantigen-specific IA, rituximab, intravenous immunoglobulin, and rescue plasma exchange, if necessary. RESULTS The study included 14 patients with AMR (acute in 9, chronic active in 5). For aAMR, mean follow-up was 13 ± 6 months, and patient and graft survival were, respectively, of 100% and 83%, with a mean increase in estimated glomerular filtration rate (eGFR) of 7.98 ± 12.96, 10.18 ± 16.71, and 11.43 ± 13.85 mL/min/1.72 m2 (P > .05) at 3, 12 months after treatment, and at the end of follow-up, respectively. For cAMR, mean follow-up was 14 ± 8 months, and patient and graft survival were, respectively, of 100% and 60%, with an average increase in eGFR of 4.30 ± 7.86, 5.64 ± 10.47, and 14.5 ± 7.86 mL/min/m2 (P > .05) at 3, 12 months after IA treatment, and at the end of the follow-up, respectively, although 40% did not respond and required chronic hemodialysis. CONCLUSION Nonantigen-specific IA with Ig-Flex columns was safe and effective for aAMR treatment in kidney transplantation. In cAMR, IA with Ig-Flex columns was associated with a satisfactory kidney graft survival, suggesting that IA could potentially offer some benefits supporting its indication in cAMR.
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Affiliation(s)
- Enrique Montagud-Marrahi
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Ignacio Revuelta
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - David Cucchiari
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Gaston J Piñeiro
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Pedro Ventura-Aguiar
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Miquel Lozano
- Apheresis Unit, Department of Hemotherapy and Hemostasis, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Joan Cid
- Apheresis Unit, Department of Hemotherapy and Hemostasis, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Jaume Martorell
- Immunology Department, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Manel Solé
- Pathology Department, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Luis F Quintana
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Federico Oppenheimer
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Fritz Diekmann
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Esteban Poch
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Josep M Campistol
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Miquel Blasco
- Nephrology and Renal Transplantation Department, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
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Bonache Tur D, Romero Baltodano K, Quintela Martínez M, Sobrado Sobrado MP, Caamaño Lado C, Montoya Echeverry AL. Resultados de la inmnuadsorción en el trasplante ABOi y el rechazo humoral en una unidad de hemodiáilsis hospitalaria. ENFERMERÍA NEFROLÓGICA 2018. [DOI: 10.4321/s2254-28842018000400008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCCIÓN
El tratamiento con inmunoadsorción no selectiva fue introducido en nuestra unidad de hemodiálisis hospitalaria con el objetivo de permitir la desensibilización previa a un trasplante renal con incompatibilidad de grupo sanguíneo y el tratamiento del rechazo mediado por anticuerpos.
OBJETIVO
Analizar los resultados de la técnica de inmunoadsorción no selectiva, en una unidad de hemodiálisis hospitalaria.
MATERIAL Y MÉTODOS
Estudio retrospectivo, descriptivo, de los primeros 18 pacientes tratados en nuestro centro con inmunoadsorción no selectiva (años 2012-2017) en las indicaciones de acondicionamiento del trasplante ABOi y tratamiento del rechazo humoral.
RESULTADOS
Durante un periodo de 5 años se analizaron un total de 128 sesiones de inmunoadsorción no selectiva. El 38,9% (n=7) de los casos para desensibilización previa al trasplante renal con incompatibilidad de grupo sanguíneo y el 61,1% (n=11) restante para el tratamiento del rechazo mediado por anticuerpos.
En el primer caso, realizaron una media de 8±0,6 sesiones de inmunoadsorción previas al trasplante renal y el 57,1% se complementaron 2 sesiones posteriores. El tratamiento concomitante fue el protocolizado con Rituximab e inmunoglobulinas, requiriendo el 57,1% la realización de recambios plasmáticos. En el segundo caso, realizaron una media de 5,9±2 sesiones de inmunoadsorción. El tratamiento concomitante fue el mismo y el 27,3% realizaron recambios plasmáticos.
CONCLUSIONES
El trasplante renal de donante vivo ABOi tras la desensibilización fue posible en el 100% de los pacientes. El 72,7% de los pacientes tratados para el rechazo mediado por anticuerpos mantienen actualmente la funcionalidad del injerto.
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Matz M, Lehnert M, Lorkowski C, Fabritius K, Weber UA, Mashreghi MF, Neumayer HH, Budde K. Combined standard and novel immunosuppressive substances affect B-lymphocyte function. Int Immunopharmacol 2013; 15:718-25. [DOI: 10.1016/j.intimp.2013.02.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 01/21/2013] [Accepted: 02/28/2013] [Indexed: 10/27/2022]
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Abstract
INTRODUCTION Renal transplantation is the best therapy for patients with end-stage renal disease. To avoid graft rejection, adequate immunosuppressive therapy is crucial. Tacrolimus is approved for prophylaxis of transplant rejection in liver, kidney or heart allograft recipients and for the treatment of allograft rejection resistant to treatment with other immunosuppressive medicinal products. AREAS COVERED The objective of this review is to summarize the clinical efficacy of tacrolimus in renal transplantation with special emphasis on acute rejection, refractory rejection and nephrotoxicity and post-transplant diabetes mellitus as typical adverse effects of the drug. EXPERT OPINION Since its approval in 1994, tacrolimus has proven its efficacy as a cornerstone of modern immunosuppressive therapy not only in numerous randomized clinical trials but also in standard clinical care. Compared with cyclosporine, the use of tacrolimus in renal transplant recipients is associated with a reduced risk for acute rejection, a reduction in the occurrence of steroid-resistant rejection and a better graft function. The avoidance of nephrotoxicity and especially post-transplant diabetes mellitus are of major interest in long-term care of renal transplant recipients.
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Affiliation(s)
- Thomas Rath
- Department of Nephrology and Transplantation Medicine, Westpfalz-Klinikum, Hellmut-Hartert Straße 1, 67655 Kaiserslautern, Germany.
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Matz M, Lehnert M, Lorkowski C, Fabritius K, Unterwalder N, Doueiri S, Weber UA, Mashreghi MF, Neumayer HH, Budde K. Effects of sotrastaurin, mycophenolic acid and everolimus on human B-lymphocyte function and activation. Transpl Int 2012; 25:1106-16. [PMID: 22816666 DOI: 10.1111/j.1432-2277.2012.01537.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Humoral rejection processes may lead to allograft injury and subsequent dysfunction. Today, only one B-cell-specific agent is in clinical use and the effects of standard and new immunosuppressant substances on B-cell activation and function are not fully clarified. The impact of sotrastaurin, mycophenolic acid and everolimus on human B-lymphocyte function was assessed by analysing proliferation, apoptosis, CD80/CD86 expression and immunoglobulin and IL-10 production in primary stimulated B cells. In addition, B-cell co-cultures with pre-activated T cells were performed to evaluate the effect of the different immunosuppressive agents on T-cell-dependent immunoglobulin production. Sotrastaurin did not inhibit B-cell proliferation, CD80/CD86 expression, and IgG production and had only minor effects on IgM levels at the highest concentration administered. In contrast, mycophenolic acid and everolimus had strong effects on all B-cell functions in a dose-dependent manner. All immunosuppressive agents caused decreased immunoglobulin levels in T-cell-dependent B-cell cultures. The data provided here suggest that mycophenolic acid and everolimus, but not sotrastaurin, are potent inhibitors of human B-lymphocyte function and activation.
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Affiliation(s)
- Mareen Matz
- Department of Nephrology, Universitätsmedizin Charité Campus Mitte, Berlin, Germany.
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Kranz B, Kelsch R, Kuwertz-Bröking E, Bröcker V, Wolters HH, Konrad M. Acute antibody-mediated rejection in paediatric renal transplant recipients. Pediatr Nephrol 2011; 26:1149-56. [PMID: 21461632 DOI: 10.1007/s00467-011-1864-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 02/12/2011] [Accepted: 02/17/2011] [Indexed: 10/18/2022]
Abstract
Acute antibody-mediated rejections (aAMR) after renal transplantation are defined by rapidly deteriorating graft function, detection of donor-specific antibodies (DSA) and characteristic histological features. In adults, anti-rejection strategies comprise intravenous immunoglobulin (IVIG), steroid pulses, plasmapheresis and rituximab. Data of children with aAMR are scarce. We report four episodes of aAMR in three children (aged 10, 10 and 11 years respectively) occurring early after renal transplantation. Pre-transplant complement-dependent cytotoxicity crossmatches were negative; in the case of re-transplantation repeated antigens were excluded. Basic immunosuppression comprised cyclosporine A, MMF and steroids. All four rejection episodes were histologically proven and associated with acute renal failure. De novo DSAs were detected in two aAMRs; one patient was additionally tested positive for AT1-receptor antibodies. All aAMRs were treated with steroid pulses, tacrolimus, MMF, IVIG, plasmapheresis and one single dose of rituximab. Despite therapy one graft was lost; in the remaining three cases kidney function re-established within 1-8 weeks. At follow-up, 14, 15 and 22 months' post-rejection their GFRs were 65, 88 and 105 ml/min/1.73 m(2) respectively. A combined therapy of steroid pulses, IVIG, plasmapheresis and rituximab is potentially effective in the treatment of aAMR in children.
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Affiliation(s)
- Birgitta Kranz
- Department of General Pediatrics, Pediatric Nephrology, University Children's Hospital Münster, Waldeyerstrasse 22, 48149 Münster, Germany.
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Eng HS, Bennett G, Chang SH, Dent H, McDonald SP, Bardy P, Coghlan P, Russ GR, Coates PTH. Donor human leukocyte antigen specific antibodies predict development and define prognosis in transplant glomerulopathy. Hum Immunol 2011; 72:386-91. [DOI: 10.1016/j.humimm.2011.02.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2010] [Revised: 12/30/2010] [Accepted: 02/03/2011] [Indexed: 10/18/2022]
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Effects of immunosuppressive drugs on purified human B cells: evidence supporting the use of MMF and rapamycin. Transplantation 2008; 86:1292-300. [PMID: 19005412 DOI: 10.1097/tp.0b013e3181874a36] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Humoral immunity is increasingly recognized as an important factor in the rejection of organ transplants. In general, humoral rejection is treated with standard immunosuppressive drugs. The direct effect of these immunosuppressive drugs on B cells is not well known. METHODS Purified human B cells devoid of T cells were stimulated with CD40L expressing L cells, or by anti-CD40 mAb with or without Toll-like receptor triggering, all in the presence of B-cell activating cytokines. These three protocols resulted in various degrees of B-cell stimulation. We added four commonly used immunosuppressive drugs (tacrolimus, cyclosporin, mycophenolic acid [MPA], and rapamycin) to these cultures and tested a variety of parameters of B-cell activity including proliferation, apoptosis induction, and both IgM and IgG production. RESULTS Tacrolimus and cyclosporin marginally inhibited B-cell proliferation and immunoglobulin production, and the extent of inhibition depended on the degree of the B-cell stimulation. In contrast, MPA and rapamycin profoundly inhibited both B-cell proliferation and immunoglobulin production, which was independent of the degree of B-cell stimulation. Both drugs induced B-cell apoptosis. Moreover, rapamycin caused a reduction in the number of B cells capable of producing immunoglobulins. CONCLUSIONS Our data show that MPA and rapamycin are capable of strongly inhibiting B cells responses. This provides a rationale for the use of both MPA and rapamycin to prevent or counteract humoral responses.
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