Therapeutic apheresis in kidney transplantation: Emerging trends

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-05-06 DOI:10.1002/jca.22119

Chimezie Godswill Okwuonu, Monarch Shah, Iram Rafique, Abdallah Saleh Abdelrazeq, Jeanne Kamal, Swati Rao, Rasheed Abiodun Balogun

{"title":"Therapeutic apheresis in kidney transplantation: Emerging trends","authors":"Chimezie Godswill Okwuonu, Monarch Shah, Iram Rafique, Abdallah Saleh Abdelrazeq, Jeanne Kamal, Swati Rao, Rasheed Abiodun Balogun","doi":"10.1002/jca.22119","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Introduction</h3>\n \n <p>The use of therapeutic apheresis (TA) either as stand-alone or adjunctive treatment in kidney transplantation has increased over the years to become a leading indication. This study shows recent trends in indications for TA related to kidney transplantation, adverse events, and patient outcome in this cohort.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This is a retrospective cohort review of adults who received TA for kidney transplant-related indications from January 1, 2017, to December 31, 2022, at the University of Virginia Medical Centre, Charlottesville, VA, USA. Data extracted include basic demographics, indication for apheresis, number of procedures, procedure characteristics, procedure-related adverse events (complications), and serum ionized calcium and serum creatinine. Data were analyzed using statistical package for social sciences (SPSS 2022 IBM Inc).</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Data from a total of 131 patients who received 860 TA procedures were analyzed. Indications for TA were antibody-mediated rejection (65.5%), recurrent focal segmental glomerulosclerosis (15%), thrombotic microangiopathy (5%), desensitization for ABO incompatibility (4.5%) and for HLA-incompatibility (4.5%), and recurrent IgA nephropathy (1%). Some adverse events were encountered in 16.7% of the procedures and include hypocalcemia (7%), vascular access malfunction (0.7%), hypotension (1.2%), arrhythmia (0.6%), and depletion coagulopathy (0.6%). The overall case mortality rate was 8.4% over the 6-year period. There was one death recorded on machine during TA resulting in a procedure-mortality rate of 0.12%.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Antibody-mediated rejection was the most common indication for TA related to kidney transplantation. Adverse events were minor and patient survival over the time was within usual limits.</p>\n </section>\n </div>","PeriodicalId":1,"journal":{"name":"Accounts of Chemical Research","volume":null,"pages":null},"PeriodicalIF":16.4000,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jca.22119","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Accounts of Chemical Research","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/jca.22119","RegionNum":1,"RegionCategory":"化学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CHEMISTRY, MULTIDISCIPLINARY","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

The use of therapeutic apheresis (TA) either as stand-alone or adjunctive treatment in kidney transplantation has increased over the years to become a leading indication. This study shows recent trends in indications for TA related to kidney transplantation, adverse events, and patient outcome in this cohort.

Methods

This is a retrospective cohort review of adults who received TA for kidney transplant-related indications from January 1, 2017, to December 31, 2022, at the University of Virginia Medical Centre, Charlottesville, VA, USA. Data extracted include basic demographics, indication for apheresis, number of procedures, procedure characteristics, procedure-related adverse events (complications), and serum ionized calcium and serum creatinine. Data were analyzed using statistical package for social sciences (SPSS 2022 IBM Inc).

Results

Data from a total of 131 patients who received 860 TA procedures were analyzed. Indications for TA were antibody-mediated rejection (65.5%), recurrent focal segmental glomerulosclerosis (15%), thrombotic microangiopathy (5%), desensitization for ABO incompatibility (4.5%) and for HLA-incompatibility (4.5%), and recurrent IgA nephropathy (1%). Some adverse events were encountered in 16.7% of the procedures and include hypocalcemia (7%), vascular access malfunction (0.7%), hypotension (1.2%), arrhythmia (0.6%), and depletion coagulopathy (0.6%). The overall case mortality rate was 8.4% over the 6-year period. There was one death recorded on machine during TA resulting in a procedure-mortality rate of 0.12%.

Conclusion

Antibody-mediated rejection was the most common indication for TA related to kidney transplantation. Adverse events were minor and patient survival over the time was within usual limits.

Abstract Image

查看原文本刊更多论文

肾移植中的治疗性血液净化：新趋势

引言多年来，治疗性无细胞疗法（TA）在肾移植中作为独立治疗或辅助治疗的使用不断增加，已成为一种主要的适应症。本研究显示了与肾移植相关的治疗性无细胞疗法适应症、不良事件和患者预后的最新趋势。方法这是对美国弗吉尼亚州夏洛茨维尔弗吉尼亚大学医学中心自 2017 年 1 月 1 日至 2022 年 12 月 31 日期间因肾移植相关适应症接受 TA 的成人进行的回顾性队列回顾。提取的数据包括基本人口统计学特征、无细胞疗法适应症、手术次数、手术特征、手术相关不良事件（并发症）以及血清离子化钙和血清肌酐。数据使用社会科学统计软件包（SPSS 2022 IBM Inc）进行分析。结果对接受过 860 例 TA 手术的 131 名患者的数据进行了分析。TA的适应症包括抗体介导的排斥反应（65.5%）、复发性局灶节段性肾小球硬化（15%）、血栓性微血管病（5%）、ABO不相容脱敏（4.5%）和HLA不相容脱敏（4.5%）以及复发性IgA肾病（1%）。16.7%的手术发生了一些不良事件，包括低钙血症（7%）、血管通路故障（0.7%）、低血压（1.2%）、心律失常（0.6%）和消耗性凝血病（0.6%）。6 年间的总体病例死亡率为 8.4%。在 TA 过程中，机器上记录了一例死亡，因此手术死亡率为 0.12%。结论抗体介导的排斥反应是肾移植最常见的TA适应症。不良事件较少，患者存活率在正常范围内。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.