Abstract
Desensitization strategies for ABO-incompatible renal transplants with plasma exchange (PE) or specific immunoadsorption (IA) decrease immunoglobulin levels. After recent measles outbreak and decreasing vaccination rates, we studied the impact of apheresis on anti-measles antibodies. Anti-measles antibodies were measured before desensitization, before transplantation and during followup in 12 patients with ABO incompatibility (2x PE only, 8x IA only, and 2x IA and PE) and 3 patients with donor-specific HLA antibodies (all PE). Patients received rituximab, IVIG, and standard immunosuppressive therapy. All patients had detectable anti-measles antibodies before desensitization (mean 3238 mU/l, range 560–8100). After 3–6 PE sessions, titers decreased significantly to 1710 mU/l (P < 0.05), in one patient to nondetectable values, while IA only maintained protective titers. After a median followup of 64 days, anti-measles antibodies returned to baseline in all patients. Immunity against measles was temporarily reduced by apheresis but remained detectable in most patients at time of transplantation. Desensitization maintains long-term protective immunity against measles.
Highlights
After recent measles outbreak and decreasing vaccination rates, we studied the impact of apheresis on anti-measles antibodies
Desensitization protocols have been successfully implemented worldwide for removal of donor-specific blood group or HLA antibodies in the recipient to allow transplantations across blood group and HLA barriers
CMV prophylaxis with cytomegalovirus immune globulin (CMVIg) was only given in the first patient postoperatively
Summary
Desensitization protocols have been successfully implemented worldwide for removal of donor-specific blood group or HLA antibodies in the recipient to allow transplantations across blood group and HLA barriers. Current therapeutic apheresis techniques to remove blood group antibodies include plasma exchange, doublefiltration apheresis, protein A immunoadsorption, and antigen-specific immunoadsorption (Glycosorb). Except for the latter, these techniques are suitable for removal of HLA antibodies [9]. Other donorspecific antibodies, such as HLA antibodies, are not removed, and removal of complement factors may offer additional advantages Both can be achieved by “unspecific” plasma exchange, which is the most common technique used worldwide due to availability. With decreasing specificity, these regimens result in increasing removal of protective immunoglobulins resulting from previous diseases or specific vaccinations. We studied the effect of various desensitization protocols on anti-measles antibodies
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