Session Name: Kidney Acute Antibody Mediated Rejection
Session Date & Time: None. Available on demand.
*Purpose: Therapeutic plasma exchange (TPE) is either performed using a highly permeable filter with standard multifunctional renal replacement equipment (mTPE) or a centrifugation device (cTPE). Although both techniques are well established in clinical practice, performance of these two modes of TPE was never compared in antibody-mediated rejection (AMR).
*Methods: A cohort retrospective study with 27 patients with AMR were analyzed between 2016 to 2020. 14 patients were treated with cTPE and 13 with mTPE. Each patient received 5 sessions of TPE, plus IV immunoglobulin and rituximab. The primary endpoints were a comparison between cTPE and mTPE efficacy in different response markers of AMR. Statistics: Data are presented as median and SD. Comparisons between both techniques and between pre-and post-TPE laboratory marker levels were performed using a paired t test. Differences were considered to be statistically significant if p values were <0.05.
*Results: Mean age was 33±9 years, 22 (81%) were living donor recipients. Sensitizing events occurred in 19 (70%). The mean AMR time appearance was 25 months (3 min- 108 max). C4d positivity in 11 (40%) patients. Both treatments were comparable at the end of 3-months post treatment in terms of decrease in creatinine levels (post cTPE 0.4 ±0.7 and post mTPE 0.2 ±0.2 mg/dL, p=0.21), increment in eGFR (post cTPE 6.4 ±16 and post mTPE 6.1 ±10 ml/min, p=0.99), panel-reactive antibody class I reduction percent (post cTPE 2 ±4 and post mTPE 2 ±4 %, p=0.91), and panel-reactive antibody class II (post cTPE 4 ±6 and post mTPE 4 ±4 %, p=0.99), DSA MFI class I reduction percent (post cTPE 41.1% and post mTPE 29.1%, p=0.55), and DSA MFI class II (post cTPE 34.8% and post mTPE 27.3%, p=0.51). (Figure 1).
*Conclusions: The improvement between cTPE and mTPE in markers of AMR response were not different between groups.
To cite this abstract in AMA style:Maggiani P, Valdestino JCRamirez, Cervantes JHCano, Avedaño ODDíaz, Castillo GGarcía, Vizcaíno MCOseguera, Covarrubias MA, Carmona MMatías, Morga DFOvando, Ramirez GRamirez, Córdoba VDLebrija, Estrada SHernandez. Membrane versus Centrifuge‑Based Therapeutic Plasma Exchange to Treat Antibody-Mediated Rejection in Kidney Transplantation [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/membrane-versus-centrifuge%e2%80%91based-therapeutic-plasma-exchange-to-treat-antibody-mediated-rejection-in-kidney-transplantation/. Accessed September 24, 2021.
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