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Ingela Fehrman - One of the best experts on this subject based on the ideXlab platform.
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abo incompatible kidney transplantations without splenectomy using antigen specific Immunoadsorption and rituximab
American Journal of Transplantation, 2005Co-Authors: G Tyden, Gunilla Kumlien, Helena Genberg, John Sandberg, Torbjorn Lundgren, Ingela FehrmanAbstract:ABO incompatible kidney transplantations have previously only been performed after several preoperative sessions of plasmapheresis and splenectomy, with the conventional triple-drug immunosuppressive protocol being reinforced with antilymphocyte globulin and B-cell-specific drugs, such as cyclophosphamide or deoxyspergualine. We have designed a protocol without splenectomy, based on antigen-specific Immunoadsorption, rituximab and a conventional triple-drug immunosuppressive protocol. The protocol calls for a 10-day pretransplantation conditioning period, starting with one dosage of rituximab and followed by full dose tacrolimus, mycophenolate mofetil and prednisolone. Antigen-specific Immunoadsorption was performed on pretransplantation days -6, -5, -2 and -1. After the last session, 0.5 g/kg of intravenous immunoglobulin (IVIG) was administered. Postoperatively, three more apheresis sessions were given every third day. Furthermore, if there was a significant increase in the antibody titers, extra sessions were considered. Eleven patients have received transplants with this protocol. The ABO antibodies were readily removed by the antigen-specific Immunoadsorption and were kept at a low level post-transplantation by further adsorptions. There were no side effects and all patients have normal renal transplant function. We conclude that after an infusion each of rituximab and IVIG, and antigen-specific Immunoadsorption; blood group-incompatible renal transplantations can be performed with excellent results using standard immunosuppression and no splenectomy.
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successful abo incompatible kidney transplantations without splenectomy using antigen specific Immunoadsorption and rituximab
Transplantation, 2003Co-Authors: G Tyden, Gunilla Kumlien, Ingela FehrmanAbstract:BACKGROUND: Historically, ABO-incompatible kidney transplantations have only been undertaken after splenectomy and unspecific plasmapheresis and with quadruple drug immunosuppression plus B-cell specific drugs. We have evaluated a protocol for ABO-incompatible kidney transplantation without splenectomy using antigen-specific Immunoadsorption, rituximab, and a conventional triple-drug immunosuppressive regimen. METHODS: The protocol called for a 10-day pretransplant conditioning period starting with one dosage of rituximab and followed by full dose tacrolimus, mycophenolate mofetil, and prednisolone. Antigen-specific Immunoadsorption was performed on pretransplant days -6, -5, -4, and -1. After the last session, 0.5 g/kg of intravenous immunoglobulin was administered. Postoperatively, three more apheresis sessions were given every third day. Furthermore, if there was a significant increase in the antibody titers, extra sessions were considered. RESULTS: Four patients have received transplants with this protocol. The donor-recipient blood groups were A2/O, B/O, B/A, and A1/O. The ABO-antibodies were readily removed by the antigen-specific Immunoadsorption and were kept at a low level posttransplantation by further adsorptions. There were no side effects, and all patients have normal renal-transplant function. CONCLUSIONS: We conclude that after one infusion each of rituximab and intravenous immunoglobulin and antigen-specific Immunoadsorption, blood-group-incompatible renal transplantations can be performed with standard immunosuppression and without splenectomy.
Tsung-hua Yang - One of the best experts on this subject based on the ideXlab platform.
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New ligand coupling procedure for formation of an Immunoadsorption wall.
ASAIO journal (American Society for Artificial Internal Organs : 1992), 2007Co-Authors: Tsung-hua Yang, Chi-lin FengAbstract:To prevent the occurrence of dialysis-related amyloidosis, an Immunoadsorption wall based on polyacrylamide has been manufactured by a recently developed, partially incomplete, two-stage polymerization method. During the preparation process, efficient utilization of coupling antibodies is the key to large-scale production of such a toxin removal modality. In this study, we attempted to carry out the ligand coupling procedure after formation of a cyanogen bromide (CNBr)-activated stationary phase, using anti-beta2-microglobulin (beta-2M) antibodies. In vitro Immunoadsorption tests show that the levels of beta-2M decrease rapidly within the first 2 hours for all the Immunoadsorption tests. After that, nearly blank values were reached for tests of initial levels of c. 30 microg/mL and c. 82 microg/mL, whereas a relatively constant level of c. 10 microg/mL was maintained for the test of initial levels of c. 185 microg/mL. The maximum surface binding capacity of the prepared Immunoadsorption walls is estimated by fitting experimental data, using a mathematical model of saturation kinetics. The present comparative investigation also suggests the manufacturing process for an Immunoadsorption wall could be improved and facilitated by this new ligand coupling procedure without compromising the resulting binding capacity. Furthermore, the experimental protocols as well as the present methodology could be helpful for development of a clinically applicable Immunoadsorption wall.
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A serial copolymerization procedure for manufacturing Immunoadsorption walls as a potential unit in conjunction with hemodialysis filters.
Artificial organs, 2006Co-Authors: Tsung-hua Yang, Chi-lin FangAbstract:A functional Immunoadsorption wall for removal of beta-2-microglobulin has been made by partially incomplete two-stage copolymerization of acrylamide with immunoadsorbent. However, a substantial amount of immunoadsorbent needs to be flushed away after the copolymerization process. Thus, to enhance the utilization efficiency of immunoadsorbent, the flushed-away immunoadsorbent was further recovered, and the copolymerization was conducted in series to produce three consecutive Immunoadsorption walls in this study. Preliminary removal tests show that similar removal patterns were obtained for these Immunoadsorption walls. Although it is not timely to conclude that a clinically applicable Immunoadsorption wall has taken shape, the development of a partially incomplete two-stage polymerization method and its associated techniques indeed provide a good basis for large-scale manufacturing Immunoadsorption walls.
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New approaches to the formation of a stationary phase in an Immunoadsorption wall.
Artificial organs, 2005Co-Authors: Tsung-hua YangAbstract:The concept of an Immunoadsorption wall, which combines the principles of immunoisolation and Immunoadsorption, was proposed in 1999 to remove certain toxins accumulated in patients' blood. However, realization of this concept is obviously handicapped by the inefficient use of immunoadsorbent. This study is intended to improve the use of immunoadsorbent and optimize the formation of a stationary phase in an Immunoadsorption wall. Polyacrylamide gel, which has the advantages of being chemically inert, having minimal diffusion effect and reasonable cost, could be considered as the medium of choice for a stationary phase. In this study, new approaches aimed at effective allocation of immunoadsorbent utilizing polyacrylamide gel are attempted. The advantages and disadvantages of these new approaches are discussed according to the preparation, formation, and outcome of a stationary phase. It is hoped that these new approaches could serve as a first step toward building an Immunoadsorption wall.
G Tyden - One of the best experts on this subject based on the ideXlab platform.
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abo incompatible kidney transplantations without splenectomy using antigen specific Immunoadsorption and rituximab
American Journal of Transplantation, 2005Co-Authors: G Tyden, Gunilla Kumlien, Helena Genberg, John Sandberg, Torbjorn Lundgren, Ingela FehrmanAbstract:ABO incompatible kidney transplantations have previously only been performed after several preoperative sessions of plasmapheresis and splenectomy, with the conventional triple-drug immunosuppressive protocol being reinforced with antilymphocyte globulin and B-cell-specific drugs, such as cyclophosphamide or deoxyspergualine. We have designed a protocol without splenectomy, based on antigen-specific Immunoadsorption, rituximab and a conventional triple-drug immunosuppressive protocol. The protocol calls for a 10-day pretransplantation conditioning period, starting with one dosage of rituximab and followed by full dose tacrolimus, mycophenolate mofetil and prednisolone. Antigen-specific Immunoadsorption was performed on pretransplantation days -6, -5, -2 and -1. After the last session, 0.5 g/kg of intravenous immunoglobulin (IVIG) was administered. Postoperatively, three more apheresis sessions were given every third day. Furthermore, if there was a significant increase in the antibody titers, extra sessions were considered. Eleven patients have received transplants with this protocol. The ABO antibodies were readily removed by the antigen-specific Immunoadsorption and were kept at a low level post-transplantation by further adsorptions. There were no side effects and all patients have normal renal transplant function. We conclude that after an infusion each of rituximab and IVIG, and antigen-specific Immunoadsorption; blood group-incompatible renal transplantations can be performed with excellent results using standard immunosuppression and no splenectomy.
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successful abo incompatible kidney transplantations without splenectomy using antigen specific Immunoadsorption and rituximab
Transplantation, 2003Co-Authors: G Tyden, Gunilla Kumlien, Ingela FehrmanAbstract:BACKGROUND: Historically, ABO-incompatible kidney transplantations have only been undertaken after splenectomy and unspecific plasmapheresis and with quadruple drug immunosuppression plus B-cell specific drugs. We have evaluated a protocol for ABO-incompatible kidney transplantation without splenectomy using antigen-specific Immunoadsorption, rituximab, and a conventional triple-drug immunosuppressive regimen. METHODS: The protocol called for a 10-day pretransplant conditioning period starting with one dosage of rituximab and followed by full dose tacrolimus, mycophenolate mofetil, and prednisolone. Antigen-specific Immunoadsorption was performed on pretransplant days -6, -5, -4, and -1. After the last session, 0.5 g/kg of intravenous immunoglobulin was administered. Postoperatively, three more apheresis sessions were given every third day. Furthermore, if there was a significant increase in the antibody titers, extra sessions were considered. RESULTS: Four patients have received transplants with this protocol. The donor-recipient blood groups were A2/O, B/O, B/A, and A1/O. The ABO-antibodies were readily removed by the antigen-specific Immunoadsorption and were kept at a low level posttransplantation by further adsorptions. There were no side effects, and all patients have normal renal-transplant function. CONCLUSIONS: We conclude that after one infusion each of rituximab and intravenous immunoglobulin and antigen-specific Immunoadsorption, blood-group-incompatible renal transplantations can be performed with standard immunosuppression and without splenectomy.
Mary Jo Drew - One of the best experts on this subject based on the ideXlab platform.
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Resolution of refractory, classic thrombotic thrombocytopenic purpura after staphylococcal protein A Immunoadsorption.
Transfusion, 1994Co-Authors: Mary Jo DrewAbstract:Background: Multiple therapeutic interventions are available for treatment of thrombotic thrombocytopenic purpura. Resolution of thrombotic thrombocytopenic purpura may require use of several of these interventions. Case Report: A patient presenting with classic (non- cancer chemotherapy-associated) thrombotic thrombocytopenic purpura had an initial response to intensive, daily plasma exchange with fresh- frozen plasma and cryosupernatant. Multiple attempts over a period of 2 months to decrease the frequency of plasma exchange resulted in exacerbations of disease activity, indicated by increased schistocytosis, decreased hematocrit, increased serum lactate dehydrogenase, and decreased platelet counts. After a total of 39 plasma exchanges, the patient was begun on Immunoadsorption therapy utilizing a staphylococcal protein A Immunoadsorption treatment column. After six 2000-mL protein A Immunoadsorption treatments, the patient's platelet count, lactate dehydrogenase, and peripheral smear normalized, and they have remained normal over nearly 4 months of follow-up. Conclusion: Treatment by protein A Immunoadsorption may be of benefit in patients with classic thrombotic thrombocytopenic purpura who are not achieving a sustained remission with conventional plasma exchange therapy.
Przemyslaw Pisarski - One of the best experts on this subject based on the ideXlab platform.
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Preemptive postoperative antigen-specific Immunoadsorption in ABO-incompatible kidney transplantation: necessary or not?
Transplantation, 2007Co-Authors: Marcel Geyer, Johannes Donauer, Przemyslaw Pisarski, Oliver Drognitz, Christian Schulz-huotari, Ursula Wisniewski, Anette Gropp, Heike Göbel, Peter Gerke, Sven TeschnerAbstract:Several standard protocols for ABO-incompatible kidney transplantation use scheduled preemptive antigen-specific Immunoadsorption during the postoperative period. Our center has developed a different approach. Our patients undergo antigen-specific Immunoadsorption postoperatively only if their isoagglutinine titers (immunoglobulin G anti-A/B) exceed 1:8 in the first postoperative week and 1:16 in the second postoperative week. Using this strategy, 22 ABO-incompatible kidney transplantations have been performed at our center since 2004. Only 32% of these patients (7 of 22) needed to undergo postoperative Immunoadsorption (mean 4.1 Immunoadsorption sessions per patient). The renal outcome in patients receiving postoperative Immunoadsorption treatment versus the outcome in patients without postoperative Immunoadsorption remained equal at a mean follow-up of 17 months. We identified a shorter pretransplant time on dialysis, a blood type constellation of donor A1/recipient O, and high initial starting titers as predictors for the need for postoperative Immunoadsorption treatment. A more detailed version of this study, with modified tables and figures, has been accepted for publication in Nephrology Dialysis Transplantation.
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abo incompatible kidney transplantation using antigen specific Immunoadsorption and rituximab a single center experience
Xenotransplantation, 2006Co-Authors: Johannes Donauer, Marcel Geyer, Jochen Wilpert, Eckhard Schwertfeger, G Kirste, O Drognitz, Gerd Walz, Przemyslaw PisarskiAbstract:: Background: For years ABO-incompatible kidney transplantations were preferentially performed in Japanese centers. In order to overcome the increased risk of humoral rejections, patients were treated with multiple sessions of plasmapheresis, intensified immunosuppressive therapy and splenectomy before transplantation. Despite good long-term results regarding patient and organ survival rates, increased morbidity during the early post-transplant period prevented a broad application of this method. Recently, a new protocol including the anti-CD20-antibody (Ab) rituximab and blood group-specific Immunoadsorption instead of splenectomy and plasmapheresis was published with excellent short-term results. Methods: From April 2004 to September 2005, 11 patients were prepared for ABO-incompatible transplantation. All patients received 375 mg/m2 rituximab intravenous 3 to 4 weeks before transplantation. Immunosuppressive therapy consisted of tacrolimus, mycophenolate mofetil and prednisone and was started at least 7 days before transplantation. Intravenous immunoglobulins (0.5 g/kg) were administered the day before transplantation. Immunoglobulin G (IgG)-anti-A or -B Ab titers before starting Immunoadsorption treatment ranged between 1 : 4 and 1 : 1024. Immunoadsorption treatment was started in parallel with immunosuppressive medication and was continued until the anti-A or anti -B Ab titers (IgG and IgM) were lowered to the aimed pre-transplant threshold of <1 : 8. During the early postoperative period, additional Immunoadsorption treatments were performed, if the titers increased again above 1 : 8 (days 0 to 7) or 1 : 16 (days 8 to 14), respectively. Results: Transplantation could be conducted in eight of 11 patients (two females, six males, mean recipient age 52±11 yr). The mean follow-up was 7.0 months (range 4 to 17). The blood group constellation was A1 to 0 in four cases, A2 to 0 in two cases, B to A in one case, and A1 to B in another case, respectively. On average, each patient received seven Immunoadsorption treatments. All transplants showed primary function and no humoral rejections occurred. Three of our 11 patients showed rapid increases of isoagglutinin titers after each Immunoadsorption treatment and thus could not be transplanted. One patient died 4 months after transplantation with a functioning graft due to sepsis secondary to pseudomembranous enterocolitis. The mean creatinine value of the remaining seven patients now is 1.6 mg/dl. Summary: The use of antigen-specific Immunoadsorption and an immunosuppressive regimen consisting of a conventional triple immunosuppressive therapy has shown excellent short-term results. The Immunoadsorption treatment using antigen-specific columns is highly effective and even patients with high isoagglutinin titers can be transplanted. This protocol is an option for end-stage renal disease patients who have no blood group-compatible donor.
