Introduction: In HLA incompatible transplantation pretransplant desensitization is mandatory in order to eliminate the donor-specific alloantibody that might fix complement (C). In a randomized crossover design we demonstrated that membrane filtration (MF) combined with immunoadsorption (IA) is significantly associated with more immunoglobulin and C1q component elimination than regular IA (Eskandary et al., NDT 2014).

C system (CS) plays a major role in graft rejection; activation of the CS is mediated by classical, alternative and lectin pathways that converge in terminal complement complex, C5b-9. Classical complement pathway is believed to play an important role as an effector of rejection. Higher mannan binding lectin (MBL) levels have been associated with more C-mediated damage resulting in severe form of rejection.

Purpose:In order to evaluate the impact of IA+MF vs. IA on global C functional activity, in a crossover study (14 patients) the soluble C5b-9 and MBL antigen levels were measured by ELISA, in order to investigate the depletion efficiency of both strategies.

Results: The addition of MF to IA was associated with a significant reduction of MBL (mean: 70 +/- 5.5%) as compared to IA alone (mean: 38.5 +/- 6.5%; p=0.0013), whereas C5b-9 was reduced to a similar extent by both techniques (IA+MF: mean: 29.4 +/- 5%; IA alone: mean: 25.5 +/- 6%; ns).

Conclusion: Our data demonstrate that the innovative strategy of association of MF to semi-selective IA substantially decreases C activation and increases the removal of MBL. These effects could represent an efficient mechanism to prevent graft rejection in incompatible transplantation.

CITATION INFORMATION: Malvezzi P, Defendi F, Eskandary F, Jouve T, Rostaing L, Dumestre-Perard C, Böhmig G. Complement Markers in Immunoadsorption Combined with Membrane Filtration. Am J Transplant. 2017;17 (suppl 3).

« Back to 2017 American Transplant Congress