Implementation of Immunoadsorption in a Nephrology Unit: The Toulouse Experience

Introduction. Plasmapheresis is widely used to remove potential deleterious antibodies from the blood. Because the volume of treated plasma is limited, plasmapheresis can be replaced by immunoadsorption (IA), a more tedious but sophisticated technique that enables treatment of larger volumes of plasma, i.e., >4 L vs. 1.5-2 L. We have implemented in our Department IA technique to replace plasmapheresis when we launched our ABO-incompatible (ABOi) and HLA-incompatible (HLAi) kidney-transplant programs with living kidney donors. In this setting, isoagglutinin titers (ABOi) or donor-specific alloantibodies (HLAi) have to be decreased drastically at pretransplant by apheresis and immunosuppression. Methods. We designed a desensitization program based on IA, which was started in the first trimester of 2010 within the Acute Polyvalent Hemodialysis and Apheresis Unit (Toulouse University Hospital, France). We describe all the steps for implementing this IA technique. So far, we have performed >225 IA sessions. Results and Conclusions. The IA sessions were associated with a net body-weight gain of ~1 kg. Normally, IA is performed first and then hemodialysis on the same or the following day; however, we were able to simultaneously perform IA with hemodialysis (tandem procedure). We are now able to conduct this procedure 24 h/7 days a week. This tandem procedure has reduced costs. Implementation of IA has enabled the successful transplantation of 32 kidney patients.