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Master Thesis

Épuration des anticorps anti-HLA par échanges plasmatiques et immunoadsorptions

Abstract : In organ transplantation, apheresis are frequently used for anti-HLA antibodies removal. However, whether plasmapheresis (PP) or semi-selective immunoadsorption (IA) should be used, and the optimal number of apheresis sessions required to reach post-treatment objectives, are still unknown. We enrolled 43 patients from Bordeaux University Hospital who were treated with PP (n=29) or IA (n=14) for antibody-mediated rejection or pre-transplant desensitization. We compared, with Single Antigen Luminex, the initial mean fluorescence intensity (MFI) of the corresponding 1416 positive beads with those obtained after 4 or 8 apheresis sessions. IA treatment and initial MFI were independently associated with success of removal after 8 sessions (MFI post-treatment < 2000) as opposed to anti-HLA antibodies class and regardless of treatment indication. For antibodies with a MFI < 6000, the efficacy was high after 4 sessions, without difference between IA and PP. For those with a MFI ≥ 6000, MFI reduction was better with IA, with a relatively low rate of removal success after 4 sessions. For anti-HLA antibodies not undergoing satisfactory removal after the first 4 apheresis sessions, the residual MFI predicted the effectiveness of 4 additional sessions, often low with PP while good with IA. In addition, the tolerance of the two techniques was similar, except for the occurrence of hypotension, more frequent with PP. Finally, IA were more expensive than PP whatever the number of sessions performed. These findings enable to propose a decisional algorithm guiding the choice of apheresis technique and the number of sessions to be performed depending on anti-HLA antibodies MFI.
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Frédéric Jambon. Épuration des anticorps anti-HLA par échanges plasmatiques et immunoadsorptions. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02432313⟩

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