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How to implement immunoadsorption in a polyvalent dialysis unit: a review
Sébastien Maggioni1, Martine Hermelin, Eric Faubel
1Department of Nephrology, Dialysis, and Organ Transplantation, CHU Rangueil, Toulouse University Hospital, Toulouse Cédex 9, France.
Journal of Renal Care
|March 20, 2014
Summary
Immunoadsorption (IA) desensitization programs improve kidney transplant success for patients with antibodies. This strategy, combining IA with hemodialysis, enhances patient care and reduces costs, enabling more successful transplants.
Area of Science:
- Nephrology
- Immunology
- Transplantation
Background:
- Kidney transplant candidates often have anti-HLA alloantibodies (HLAi), complicating transplantation, especially from living kidney (LK) donors.
- ABO incompatibility (ABOi) also limits LK transplants due to donor shortages.
- Desensitization strategies are crucial for ABOi and/or HLAi patients awaiting kidney transplants.
Purpose of the Study:
- To describe the design and implementation of an immunoadsorption (IA) based desensitization program.
- To evaluate the efficiency and outcomes of IA compared to plasmapheresis (PP) for desensitization.
- To optimize IA procedures for improved patient care and transplant success.
Main Methods:
- Developed and implemented an IA desensitization program in Toulouse University Hospital starting in 2010.
- Utilized IA, which can treat larger plasma volumes than PP, for both ABOi and HLAi settings.
- Successfully coupled IA with hemodialysis, a novel approach, and established a 24/7 operational capacity.
Main Results:
- Over 200 IA sessions were performed with positive outcomes.
- IA sessions were associated with a minor net body-weight gain of approximately 1 kg.
- The coupled IA-hemodialysis procedure was successfully implemented.
Conclusions:
- The IA desensitization program has significantly improved patient care and reduced healthcare costs.
- This innovative approach has facilitated successful kidney transplantation in 24 patients to date.
- IA offers a more efficient and adaptable desensitization method for challenging transplant candidates.
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