Utilization of Plasmapheresis and High Dose of Immunoglobulins in the Treatment of the High Level of De Novo Donor Specific Antibodies for the Successful Islet Allotransplantation.
1Surgery, University of Chicago, Chicago, IL
2Medicine, University of Chicago, Chicago, IL
3Internal Medicine, Medical University of Gdansk, Gdansk, Poland
4Family Medicine, Medical University of Gdansk, Gdansk, Poland.
Meeting: 2016 American Transplant Congress
Abstract number: A69
Keywords: Alloantibodies, Islets, IVIG, Plasmapheresis
Session Information
Session Name: Poster Session A: Clinical Pancreas Transplantation and All Islet Cell Transplantation Topics
Session Type: Poster Session
Date: Saturday, June 11, 2016
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Halls C&D
Background.
Development of donor specific antibodies (DSA) after islet transplantation has been a poor prognostic factor for graft survival, while no intervention is implemented. Here, we present 2 patients who developed de novo DSA and high panel of reactive antibodies (PRA) and become insulin independent after treatment and a subsequent islet infusion.
Material and Method.
Two patients with PRA zero received infusion of islet allograft in amount of 8,363 IEQ/kg and 5,900 IEQ/kg, respectively. They received anti-thymocyte globulin as induction and tacrolimus and myfortic as maintenance immunosuppressive therapy. During the second islet transplant basiliximab was used for the induction.
Results.
On day 7 after the transplant, first patient developed PRA of 89% with high DSA (B57, B62, Bw4). He lost his serum c-peptide in next few days despite treatment with steroids (3x 500mg of solumedrol) and initiation of plasmapheresis with subsequent high dose of immunoglobulin (IVIG). Subsequently, his PRA declined to zero and remained so afterwards. He maintained on low dose of immunosuppression until subsequent islet transplant (5,800IEQ), which allowed him to wean off insulin completely with current A1c of 5.8 ten months later.
Second patient developed PRA of 95% with high DSA (DQ4, DQ6) found on day 75 with still good islet function requiring only 15u of insulin. Course of plasmapheresis with high dose IVIG and anti-CD20 antibody allowed for complete resolution of PRA, maintaining stable partial islet graft function and subsequent successful islet transplantation. Patient still has been remaining for over a year off insulin without recurrence of PRA with A1c 5.7. Of note, both patient developed anti-GAD antibody at high titters, which raised and declined in parallel to PRA.
Conclusion.
De novo PRA/DSA after islet transplant can be successfully treated utilizing plasmapheresis and IVIG. Subsequent islet transplant from properly matched donor can improve overall outcome leading to the insulin independence and stable islet function.
CITATION INFORMATION: Solomina J, Tekin Z, Matosz S, Golab K, Thomas C, Golebiewska J, Ramachandran S, Schenck L, Chon W, Tibudan M, Marek-Trzonkowska N, Millis J, Witkowski P. Utilization of Plasmapheresis and High Dose of Immunoglobulins in the Treatment of the High Level of De Novo Donor Specific Antibodies for the Successful Islet Allotransplantation. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Solomina J, Tekin Z, Matosz S, Golab K, Thomas C, Golebiewska J, Ramachandran S, Schenck L, Chon W, Tibudan M, Marek-Trzonkowska N, Millis J, Witkowski P. Utilization of Plasmapheresis and High Dose of Immunoglobulins in the Treatment of the High Level of De Novo Donor Specific Antibodies for the Successful Islet Allotransplantation. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/utilization-of-plasmapheresis-and-high-dose-of-immunoglobulins-in-the-treatment-of-the-high-level-of-de-novo-donor-specific-antibodies-for-the-successful-islet-allotransplantation/. Accessed May 9, 2025.« Back to 2016 American Transplant Congress