Anti-HLA antibody removal by extracorporeal immunoadsorption in two hyperimmunized pediatric patients awaiting hepatointestinal transplantation.

TSCHERNIA A,; LELEIKO NS; GRIMA K; WHITTSET C; MOLNAR K; SPENCER RW ; SLOVES MF; GONDOLESI G; KAUFMAN SS; FISHBEIN TM

TRANSPLANTATION PROCEEDINGS

ELSEVIER SCIENCE INC

Lugar: Amsterdam; Año: 2002 vol. 34 p. 900 - 901

0041-1345

PRODUCTION OF antibodies against human leukocyteantigens (HLA) may occur following chronic dialysis,unprotected sexual activity, pregnancy, and repeated bloodtransfusions. A high rate of graft loss results when renal andcardiac transplantation is performed in patients possessingthese antibodies in high titer in association with a positivelymphocyte cross-match with prospective donor organs.Pretransplantation reduction in the levels of these antibodiesis therefore important, and different strategies havebeen considered. One approach is extracorporeal immunoadsorption(IA), consisting of plasma filtration throughcolumns containing immunoglobulin-binding adsorbentmedia, which has been successfully used in kidney transplantation.1?3In contrast with kidney, and probably heartand lung transplantation, presence of preformed anti-HLAantibodies are relatively unimportant to outcome of livertransplantation and are of uncertain importance in intestinaltransplantation. Rejection of the intestinal transplant isboth frequent and severe, often resulting in mucosal exfoliationand graft loss. In an attempt to assess the risk andreduce incidence of severe rejection, we have routinelyquantified panel-reactive anti-HLA antibodies (PRA) incandidates for intestinal transplantation at our institution.We now report our experience in two patients whodemonstrated extraordinarily high levels of sensitizationbased on PRA testing. We performed IA before transplantationin these patients to ascertain the feasibility of obtaininga negative cross-match and thereby reduce the probabilityof severe rejection.