PMID- 36196288
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20221007
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 14
IP  - 9
DP  - 2022 Sep
TI  - Efficacy of Combined Desensitization Therapy Based on Protein A Immunoadsorption 
      on Anti-human Leukocyte Antigen Antibodies in Sensitized Kidney Transplant 
      Recipients: A Retrospective Study.
PG  - e28661
LID - 10.7759/cureus.28661 [doi]
LID - e28661
AB  - Background and objectives Protein A immunoadsorption (PA-IA) therapy is an 
      immunoglobulin selective apheresis for pre-transplantation desensitization 
      therapy and treatment of post-transplantation antibody-mediated rejection. There 
      is no unified protocol for the timing of PA-IA therapy or its combination with 
      other drug therapy. This study aimed to investigate and analyze the clearance 
      effects of desensitization therapy on human leukocyte antigen (HLA) antibodies to 
      provide a reference for the formulation of clinical desensitization therapy 
      regimens. Materials and methods Overall, 27 kidney transplant recipients who 
      received preoperative/postoperative desensitization therapy based on PA-IA 
      therapy in combination with drug therapy were enrolled. The pre-treatment mean 
      fluorescence intensity (MFI) of 1324 human leukocyte antigen (HLA) antibody 
      specificities (MFI >2000) and the post-treatment MFI of the corresponding 
      antibody specificities (after one, four, seven, and 10 sessions) were recorded to 
      analyze the changes in antibody level reduction for the different antibody 
      classes and MFI ranges. Results After 10 sessions of PA-IA therapy, the MFI of 
      class I antibodies decreased from 8298.56 to 3196.15 (reduction of 66.80%), while 
      the MFI of class II antibodies decreased from 13,521.09 to 2773.29 (reduction of 
      71.14%). The pre-treatment level of class II antibodies was significantly higher 
      than that of class I antibodies (p<0.001), whereas the post-treatment levels of 
      class I and II antibodies were comparable (p>0.05). The clearance effects of 
      PA-IA therapy were greater for strongly positive (MFI>10,000) class II antibodies 
      than for strongly positive class I antibodies, showing a reduction of 62.59% 
      (25.17% to 91.04%) and 45.13% (32.70% to 73.94%), respectively (p=0.015). 
      Conclusions We confirmed the removal efficacy of PA-IA for HLA antibodies. The 
      removal efficacy of class II antibodies on PA-IA is not inferior to that of class 
      I. Under an adequate number of treatment sessions, the clearance effect of PA-IA 
      therapy for strongly positive class II antibodies may be greater than that for 
      strongly positive class I antibodies.
CI  - Copyright (c) 2022, Chen et al.
FAU - Chen, XiaoFei
AU  - Chen X
AD  - Nephrology, Shulan (Hangzhou) Hospital, Zhejiang Shuren University Shulan 
      International Medical College, HangZhou, CHN.
FAU - Wang, YuXian
AU  - Wang Y
AD  - Nephrology, Shulan (Hangzhou) Hospital, Zhejiang Shuren University Shulan 
      International Medical College, HangZhou, CHN.
FAU - Dong, PeiJian
AU  - Dong P
AD  - Research and Development, GuangDong Provincial Key Laboratory of Hemoadsorption 
      Technology, GuangZhou, CHN.
FAU - Wang, JiaMei
AU  - Wang J
AD  - Nephrology, Shulan (Hangzhou) Hospital, Zhejiang Shuren University Shulan 
      International Medical College, HangZhou, CHN.
FAU - Yu, XiaoTian
AU  - Yu X
AD  - Nephrology, Shulan (Hangzhou) Hospital, Zhejiang Shuren University Shulan 
      International Medical College, HangZhou, CHN.
FAU - Yu, BoGuang
AU  - Yu B
AD  - Research and Development, GuangDong Provincial Key Laboratory of Hemoadsorption 
      Technology, GuangZhou, CHN.
LA  - eng
PT  - Journal Article
DEP - 20220901
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC9525051
OTO - NOTNLM
OT  - anti-human leukocyte antigen antibodies
OT  - desensitization therapy
OT  - graft rejection
OT  - kidney transplantation
OT  - protein a immunoadsorption
COIS- The authors have declared that no competing interests exist.
EDAT- 2022/10/06 06:00
MHDA- 2022/10/06 06:01
PMCR- 2022/09/01
CRDT- 2022/10/05 01:47
PHST- 2022/08/31 00:00 [accepted]
PHST- 2022/10/05 01:47 [entrez]
PHST- 2022/10/06 06:00 [pubmed]
PHST- 2022/10/06 06:01 [medline]
PHST- 2022/09/01 00:00 [pmc-release]
AID - 10.7759/cureus.28661 [doi]
PST - epublish
SO  - Cureus. 2022 Sep 1;14(9):e28661. doi: 10.7759/cureus.28661. eCollection 2022 Sep.