Plasma exchanges therapy is traditionally part of anti-HLA desensitization strategies used in kidney transplantation. As compared to conventional techniques of plasma exchanges (PE) (plasma-centrifugation or filtration), immuno-adsorption (IAD) on protein A coated-columns offers in theory a higher specificity for IgG and might be more efficient in depleting anti-HLA antibodies. However, no direct comparison between the 2 techniques exists.

We tested the hypothesis that a single session of IAD would be as efficient as 3 sessions of PE in decreasing the level of anti-HLA sensitization.

We determined by single antigen LUMINEX the Mean Fluorescence Intensity (MFI) of anti-HLA antibodies before/after one session of IAD (Immunosorba©, 2.5 liters of plasma volume treated by session) or before/after 3 consecutive daily PE (PRISMAFLEX© or OPTIA© systems, 1.2 liter of plasma volume treated by session, 3.6 liters for 3 sessions). We assessed the Relative Variation (RV) of MFI as the difference between pre- and post-treatment MFI values divided by pre-treatment MFI value. MFI values were compared using a paired Wilcoxon signed-rank test.

MFI variations of a total of 410 anti-HLA antibodies were analyzed (157 after one IA session and 243 after 3 consecutive PE). Irrespective of the technique used, MFI decreased from 4735 [IQR: 2597-7777] to 2061 [IQR: 700-4302] (p<0.001). RV of MFI was -65.0%[-77.7;-24.3;] and -65.4%[-79.5;-41.4] after one IAD and after 3 PE, respectively (p=0.46). One session of IAD was even significantly superior to 3 sessions of PE for the depletion of anti-class I HLA antibodies (-72.4% vs -69.2% after one IAD and after 3 PE, respectively, p=0.014).

We conclude that protein A-based IAD is more effective in depleting anti-HLA antibodies than conventional PE therapies and should be preferentially evaluated in desensitization protocols.

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