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Plasma Exchanges (plasma + exchanges)
Selected AbstractsPlasmapheresis as rescue therapy in accelerated acute humoral rejection,JOURNAL OF CLINICAL APHERESIS, Issue 3 2003Kottarathil A. Abraham Abstract Accelerated acute humoral rejection (AHR) continues to occur in renal transplantation despite improved crossmatching, with potentially devastating consequences. Between 1 June 1998 and 31 December 2000, 440 renal transplants were performed in our center. AHR was diagnosed by the demonstration of typical pathological features on renal histology and positive direct immunofluorescence or detection of anti-HLA antibodies in serum. AHR developed in 20 (4.5%) of our renal transplant recipients, nine male and eleven female at an average of 16.3 days post transplantation. All of these patients had a negative current cytotoxic crossmatch prior to transplantation. The median serum creatinine at diagnosis was 5.96 mg/dL, and 83% of these individuals developed oliguric renal failure requiring dialysis after having initially attained good graft function (median of best serum creatinine before AHR was 2.64 mg/dL). The 18 recipients who had not infarcted their grafts at the time of diagnosis of AHR received plasmapheresis in conjunction with intensification of their immunosuppressive regimen. This regimen was successful in reversing AHR in 78% of those treated with apheresis. In the 14 responders, graft survival at 6 months was 100% and at 12 months was 91%. Median serum creatinine at 6 and 12 months was 1.26 and 1.33 mg/dL, respectively. Patients received an average of 8.1 plasma exchanges. However, responders received a significantly higher frequency of plasmapheresis (P = .0053), despite undergoing a similar number of exchanges overall. Plasmapheresis appears to be an effective modality for reversing AHR and maintaining graft function. J. Clin. Apheresis 18:103,110, 2003. © 2003 Wiley-Liss, Inc. [source] Prospective investigation of a subcutaneous, implantable central venous access device for therapeutic plasma exchange in adults with neurological disordersJOURNAL OF CLINICAL APHERESIS, Issue 1 2002Basilio Pertiné Abstract Standard alternatives to antecubital access for long-term therapeutic plasma exchange, including percutaneous polyurethane or tunneled silicone catheters, are associated with complications and inconvenience for the patient. We have investigated the Bard CathLink® 20, a subcutaneously implantable central venous access device, as an alternative for outpatient plasma exchange. The CathLink® 20 consists of a funnel-shaped titanium port connected to a soft polyurethane-derived catheter and is accessed percutaneously using an 18-gauge catheter-over-needle Angiocath®. Six patients with paraproteinemic polyneuropathies underwent 64 outpatient plasma exchanges using the CathLink® 20 for access, 31 using 2 CathLink® 20's (draw and return), 20 using a single CathLink® 20 as the draw site and 13 using a single CathLink® 20 as the return site. Mean (± SD) plasma removed was 3,680 ± 551 ml in 115.2 ± 25.3 min. Apheresis personnel were able to access the ports in 1.23 ± 0.6 attempts per port per procedure. Six of 70 planned procedures were aborted: 3 because of failure of an antecubital access site and 3 because of catheter occlusion resolved using a thrombolytic agent. Whole blood flow rate was approximately 54 ml/min, and plasma flow rate was about 32 ml/min for 135 min. Access pressures were stable at ,150 to ,200 torr (P = 0.1395). Return line pressures varied between 90 and 130 torr (P = 0.0147). No patient required hospitalization during the study. Though not optimized for apheresis, the CathLink® 20 provides a reasonable option for chronic apheresis patients who lack adequate peripheral venous access. J. Clin. Apheresis 17:1,6, 2002. © 2002 Wiley-Liss, 2002. [source] Intensive and Prolonged Treatment of Focal and Segmental Glomerulosclerosis Recurrence in Adult Kidney Transplant Recipients: A Pilot StudyAMERICAN JOURNAL OF TRANSPLANTATION, Issue 5 2009G. Canaud No treatment has consistently induced long-term remission of proteinuria in adult patients with focal segmental glomerulosclerosis (FSGS) recurrence after kidney transplantation. We undertook an open-label, nonrandomized pilot trial of intensive and prolonged treatment of FSGS recurrence. Over an 18-month period, 10 adult kidney transplant recipients with FSGS recurrence received concomitantly high-dose steroids, intravenous cyclosporine for 14 days followed by oral cyclosporine therapy, and an intensive and prolonged course of plasma exchanges (PE). We compared this treatment with those of a control group of 19 patients with a FSGS recurrence transplanted between 1997 and 2005. Complete, rapid (mean 23 ± 7 days) and sustained remission was obtained in 9/10 patients (90%) as opposed to 27% in the control group. At month 3 and month 12, proteinuria was 0.16 g/day (range 0.05,0.3 g/day) and 0.19 g/day (range 0.05,1 g/day) respectively. Only one patient remained in partial remission at month 12 but he had already lost two previous grafts due to FSGS recurrence. PEs were stopped at month 9 in all patients except for the patient with a partial remission who remains PE-dependent. This small pilot study provides very encouraging results demonstrating that this treatment rapidly achieves complete and sustained remission in a high proportion of patients. [source] Anti-Factor H Autoantibodies in a Fifth Renal Transplant Recipient with Atypical Hemolytic and Uremic SyndromeAMERICAN JOURNAL OF TRANSPLANTATION, Issue 5 2009M. Le Quintrec Hemolytic uremic syndrome (HUS) associated with anti-Factor H (anti-FH) autoantibodies is a recently described pathophysiological entity. Monitoring of anti-FH IgG titer may be a sensitive marker of disease activity and guide treatment to eliminate circulating anti-FH antibodies. We report here a case of atypical HUS (aHUS) in which anti-FH autoantibodies were detected during the course of a fifth kidney transplant, 30 years after the first flare of aHUS. This exceptional case suggests that early, specific management based on immunosuppressive therapy and plasma exchanges monitored by anti-FH IgG titer may result in long-term graft survival. [source] Successful Anti-TNF, Treatment in a Child with Posttransplant Recurrent Focal Segmental GlomerulosclerosisAMERICAN JOURNAL OF TRANSPLANTATION, Issue 4 2009S. Leroy Posttransplant recurrence of focal and segmental glomulosclerosis (FSGS) occurs in ,30% of patients, and remains after uncontrolled despite increased immunosuppression and plasma exchanges (PE) in ,30% of cases. New immunosuppressive drugs might then be warranted. We report the case of a 15-year-old boy with FSGS leading to end-stage renal disease (ESRD) who presented with an early posttransplant recurrence of disease. Reinforced immunosuppression and PE resulted in partial and transient disease control, but proteinuria significantly decreased with anti-TNF, treatment (infliximab then etanercep). This is the first case report of successful anti-TNF, treatment despite a constant high activity of FSGS, as demonstrated by relapse after discontinuation of anti-TNF, agents. [source] Refractory thrombotic thrombocytopenic purpura following influenza vaccinationANAESTHESIA, Issue 4 2009P. J. Dias Summary Thrombotic thrombocytopenic purpura (TTP) is characterised by the systemic microvascular aggregation of platelets causing ischaemia of the brain and other organs. We describe the case of a 54 year-old man who presented with neurological signs, fever, severe thrombocytopenia, microangiopathic haemolytic anaemia and renal failure 5 days after receiving an influenza vaccination. He was diagnosed with acute refractory TTP caused by autoantibody-mediated ADAMTS-13 deficiency. He required stabilisation on the critical care unit before being successfully treated with 3 l plasma exchanges for 21 days and rituximab (MabThera®) at a dose of 375 mg.m,2, given weekly for a total of 4 weeks. Vaccination is an important part of preventative medicine and reduces morbidity and mortality. Only in a few rare cases has vaccination been associated with autoimmune pathology. We could find only one similar case report of thrombotic thrombocytopenic purpura following influenza vaccination. In addition to plasma exchange, rituximab appears to be effective and well tolerated in the treatment of refractory thrombotic thrombocytopenic purpura. [source] Rituximab may form a complex with iGm, mixed cryoglobulin and induce severe systemic reactions in patients with hepatitis C virus,induced vasculitisARTHRITIS & RHEUMATISM, Issue 12 2009Damien Sène Objective To report on 6 cases of hepatitis C virus (HCV),induced mixed cryoglobulinemia (MC) vasculitis in patients who developed severe systemic reactions after rituximab infusion, and to report the results of the in vitro analysis of the underlying immunologic mechanisms. Methods Twenty-two HCV-infected patients with MC vasculitis received rituximab infusions (a low-dose protocol cycle with 375 mg/m2/week for 4 consecutive weeks in 18 patients and a high-dose protocol cycle with 1,000 mg on days 1 and 15 in 4 patients). Systemic drug reactions following rituximab infusion were recorded and analyzed clinically and immunochemically. Results Six of 22 patients (27.3%) experienced systemic drug reactions after rituximab infusion. Four patients developed a severe flare of MC vasculitis 1 or 2 days after rituximab infusion. Two patients developed serum sickness syndrome 7 and 9 days after the first 1,000 mg rituximab infusion. Compared with patients without drug reactions, those with drug reactions had higher mixed cryoglobulin levels (mean ± SD 1.4 ± 0.82 gm/liter versus 0.71 ± 0.77 gm/liter; P = 0.0475) and lower C4 levels (mean ± SD 0.02 ± 0.006 gm/liter versus 0.07 ± 0.07 gm/liter; P = 0.02), and more of them received 1,000 mg high-dose rituximab protocol (50% versus 6.25%; P = 0.046). In vitro immunochemical assays showed that rituximab formed a complex with the cryoprecipitating IgM, that had rheumatoid factor (RF) activity. Moreover, the in vitro addition of rituximab to serum containing an RF-positive IgM, type II mixed cryoglobulin was associated with visibly accelerated cryoprecipitation. Conclusion In HCV-associated MC vasculitis, rituximab may form a complex with RF-positive IgM,, leading to accelerated cryoprecipitation and to severe systemic reactions. Rituximab should be administered with caution in MC vasculitis, with use of the 375 mg protocol and plasma exchanges prior to rituximab infusion in patients with high baseline levels of mixed cryoglobulin. [source] Role of methylene blue-treated or fresh-frozen plasma in the response to plasma exchange in patients with thrombotic thrombocytopenic purpuraBRITISH JOURNAL OF HAEMATOLOGY, Issue 3 2001Javier De La Rubia Twenty patients with thrombotic thrombocytopenic purpura (TTP) underwent plasma exchange using either standard fresh-frozen plasma (Group A, n = 13) or methylene blue-treated plasma (Group B, n = 7). Both groups presented similar characteristics except that bilirubin values were higher in Group A (P < 0·05). The complete remission rate was higher in Group A than B (69% versus 57%). The mean number of procedures was higher in Group B (21 ± 7 versus 11 ± 3, P < 0·01) and the mean duration of hospitalization was also longer (37 ± 12 d versus 22 ± 11 d; P < 0·01). Our study shows that the use of methylene blue-treated fresh-frozen plasma to treat TTP is associated with a higher number of plasma exchanges and greater transfusion requirements without improving clinical results. [source] | ||||||||||