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Hemodialysis treatment combined with plasma exchange in the patient candidate for transplantation of living kidney kidney ABO incompatible
Padua, 4 July 2018 – For the first time, at the Hospital of Padua, the combined procedure – technique TANDEM of two extracorporeal treatments within the framework of transplantation program was implemented living kidney incompatible donor ABO.
The operational units involved are: Immunotransfusion: Dr. Piero Marson, Dott.ssa Tiziana Tison, Dr. Anna Colpo, Director dott.ssa Giustina De Silvestro; Nephrology: Dr. Barbara Rossi, Dr. Marianna Alessi, Director Prof. Lorenzo Calò; Kidney and Pancreas Transplants: Dr Lucrezia Furian, Dr Cristina Silvestre, Dr Flavia Neri, Director Prof. Paolo Rigotti
The kidney transplantation program of live donor incompatible with ABO provides a multidisciplinary approach to the patient and in particular our UOC are involved in the treatment of hemodialysis – Nephrology 2 and in the determination and control of the title of isohemagglutinins and the treatment of pre-transplantation – Immuno-fusion desensitization
Desensitization is performed with aeropenetic therapy: plasma exchange or selective / superselective immunoadsorption, in combination with administration of immunosuppressive drugs, to reduce the titer of isohemagglutinins and thereby overcome the immunological barrier of ABO incompatibility.
Up to now, the patient in chronic hemodialysis candidate for transplantation of an ABO-incompatible donor kidney was subjected, every other day, to hemodialysis and apheresis, with consequent discomfort for the patient himself. even, especially in cases of elevated titers of isohemagglutinins, which also required apheresis procedures 7-8, which were added to the chronic hemodialysis program performed three times a week. [19659005] In order to allow the patient a less stressful pre-transplantation period and to optimize the space and personnel resources involved in the desensitization procedure, a working group was created involving various professional personalities: doctors, nurses and technicians , in order to develop treatment TANDEM also to our hospital.
The patient who was an incompatible ABO transplant was in chronic hemodialysis treatment in another institution. Following the preliminary fitness visit and adequate information, the patient was sent to TANDEM treatment after giving his consent.
During TANDEM treatments adverse events were verified and no significant difference in the efficacy of the procedures was found. The patient transplanted from an incompatible ABO living donor has returned to his normal functions.
Based on this experience, we believe that after appropriate treatment, treatment TANDEM can be applied and is safe and effective. ; moreover, it can guarantee a better quality of life for ABO kidney transplant patients, which considerably reduces the number of hospital visits during the graft preparation phase
A few years ago renal transplantation the recipient belonged to the same blood group: this barrier was called the "ABO immunological barrier" and was considered unsurpbadable. This is not the only immunological barrier of the graft: the other obstacle is represented by the HLA system, ie by the set of characteristics present on the cells of our organization that differentiates us from all others. [19659005Todayitispossibletoovercometheseobstaclesthankstoadvancesinbadistivetechnologiesandimmunosuppressivedrugs:thusevenforalongtimethehospitalprogramhbadtartedaprogramofrenaltransplantationoflivingdonorsincompatiblemainlyfortheABOgroup[19659005] It is clear that the patient must be adequately prepared to receive an organ with a different blood group and therefore, in the preparation program, the candidate to receive a new organ must continue to do the dialysis, which for him saves the life, but also treatments such as therapeutic plasmapheresis.
This is a procedure that involves the elimination of plasma iente, in which there are those antibodies that could reject the new organ, replacing it with an equal volume of fluids and proteins, so that the patient keeps an adequate balance: it is a kind of blood turnover, which maintains the cell quota
The patient who follows this program, for a period before transplantation, must go to the hospital every day to do a dialysis and a day plasmapheresis alternately: and here is the novelty. This technique TANDEM was developed to do both treatments simultaneously: at the same time and at the same place
In Italy the technique TANDEM is reported in pediatrics and the international literature reports some experiences abroad. Now the technique TANDEM Hemodialysis + Plasma Exchange is performed in Padua also in adult patients and the hospital is one of the leading transplantation centers in Europe thanks to the spirit collaboration and optimal initiative of all health care workers.
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