The role of immunomodulation in ABO-incompatible adult liver transplant recipients
Background: ABO‐incompatible (ABO‐i) liver transplantation (LT) is a high‐risk procedure due to the potential for antibody‐mediated rejection (AMR) and cell‐mediated rejection. The aim of the current report is to illustrate the results of a retrospective comparison study on the use of immunomodulati...
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| Veröffentlicht in: | Journal of clinical apheresis 2008, Vol.23 (2), p.55-62 |
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| creator | Urbani, Lucio Mazzoni, Alessandro Bianco, Irene Grazzini, Tiziana De Simone, Paolo Catalano, Gabriele Montin, Umberto Petruccelli, Stefania Morelli, Luca Campani, Daniela Pollina, Luca Biancofiore, Gianni Bindi, Lucia Tascini, Carlo Menichetti, Francesco Scatena, Fabrizio Filipponi, Franco |
| description | Background:
ABO‐incompatible (ABO‐i) liver transplantation (LT) is a high‐risk procedure due to the potential for antibody‐mediated rejection (AMR) and cell‐mediated rejection. The aim of the current report is to illustrate the results of a retrospective comparison study on the use of immunomodulation with therapeutic plasma exchange (TPE) associated to high‐dose immunoglobulins (IVIg) and extracorporeal photopheresis (ECP) in ABO‐i adult LT patients.
Patients and methods:
Between January 1996 and December 2005, 19 patients underwent ABO‐i LT. The study was designed for a comparison between two groups of ABO‐i LT. Group 1 (control group) consisted of 11 patients treated with TPE only. Group 2 (study group) included eight patients treated with TPE and IVIg. Moreover, all Group 2 patients received acute rejection prophylaxis with ECP.
Results:
The graft survival at 6, 12, and 18 months was 63.6, 54.4, and 45.5% for Group 1 vs. 87.5, 87.5, and 87.5% for Group 2 (P ≤ 0.001). In Group 1 there were 3(27.3%) cases of AMR; 5 (45.4%) biopsy‐proven acute rejections (BPAR); 1 (9.1%) chronic rejection and 3 (27.3%) ischemic‐type biliary lesions (ITBL). In Group 2 there were no cases of AMR, BPAR, chronic rejection, or ITBL (P = 0.013).
Conclusion:
At median follow‐up of 568 days, TPE in combination with IVIg and ECP appears to protect the graft from AMR in ABO‐i liver transplantation. Continued patient enrollment will allow validation of these preliminary observations or the opportunity to devise newer AMR‐avoidance policies. J. Clin. Apheresis 2008. © 2008 Wiley‐Liss, Inc. |
| doi_str_mv | 10.1002/jca.20156 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_70482239</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>70482239</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4276-1071fa147ff2d28a3b8484949d6ec01b7b893e848a46d78238faf211e25f49433</originalsourceid><addsrcrecordid>eNp1kMtOwzAQRS0EglJY8AMoKyQWAb8SO8tS0ZYKgQRFLC0nsYUhiYOdAP17DCmwYjXSzLlXowPAEYJnCEJ8_lzIMwxRkm6BEYIZjxGCaBuMICMkxjTJ9sC-988QwiwjyS7YQxzxNMFsBO5WTypytlKR1ZGp676xtS37SnbGNpFposnFbWyawtZtWOWBk-HaRZV5Uy7qnGx8W8mmi5wqTGtU0_kDsKNl5dXhZo7Bw-xyNV3E17fzq-nkOi4oZmmMIENaIsq0xiXmkuSccprRrExVAVHOcp4RFXaSpiXjmHAtNUZI4UQHjJAxOBl6W2dfe-U7URtfqCq8o2zvBYOUY0yyAJ4OYOGs905p0TpTS7cWCIovgSIIFN8CA3u8Ke3zWpV_5MZYAM4H4N1Uav1_k1hOJz-V8ZAwvlMfvwnpXkTKCEvE481cLG5m9xerJRUp-QSeQoi6</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>70482239</pqid></control><display><type>article</type><title>The role of immunomodulation in ABO-incompatible adult liver transplant recipients</title><source>Wiley Online Library - AutoHoldings Journals</source><source>MEDLINE</source><creator>Urbani, Lucio ; Mazzoni, Alessandro ; Bianco, Irene ; Grazzini, Tiziana ; De Simone, Paolo ; Catalano, Gabriele ; Montin, Umberto ; Petruccelli, Stefania ; Morelli, Luca ; Campani, Daniela ; Pollina, Luca ; Biancofiore, Gianni ; Bindi, Lucia ; Tascini, Carlo ; Menichetti, Francesco ; Scatena, Fabrizio ; Filipponi, Franco</creator><creatorcontrib>Urbani, Lucio ; Mazzoni, Alessandro ; Bianco, Irene ; Grazzini, Tiziana ; De Simone, Paolo ; Catalano, Gabriele ; Montin, Umberto ; Petruccelli, Stefania ; Morelli, Luca ; Campani, Daniela ; Pollina, Luca ; Biancofiore, Gianni ; Bindi, Lucia ; Tascini, Carlo ; Menichetti, Francesco ; Scatena, Fabrizio ; Filipponi, Franco</creatorcontrib><description>Background:
ABO‐incompatible (ABO‐i) liver transplantation (LT) is a high‐risk procedure due to the potential for antibody‐mediated rejection (AMR) and cell‐mediated rejection. The aim of the current report is to illustrate the results of a retrospective comparison study on the use of immunomodulation with therapeutic plasma exchange (TPE) associated to high‐dose immunoglobulins (IVIg) and extracorporeal photopheresis (ECP) in ABO‐i adult LT patients.
Patients and methods:
Between January 1996 and December 2005, 19 patients underwent ABO‐i LT. The study was designed for a comparison between two groups of ABO‐i LT. Group 1 (control group) consisted of 11 patients treated with TPE only. Group 2 (study group) included eight patients treated with TPE and IVIg. Moreover, all Group 2 patients received acute rejection prophylaxis with ECP.
Results:
The graft survival at 6, 12, and 18 months was 63.6, 54.4, and 45.5% for Group 1 vs. 87.5, 87.5, and 87.5% for Group 2 (P ≤ 0.001). In Group 1 there were 3(27.3%) cases of AMR; 5 (45.4%) biopsy‐proven acute rejections (BPAR); 1 (9.1%) chronic rejection and 3 (27.3%) ischemic‐type biliary lesions (ITBL). In Group 2 there were no cases of AMR, BPAR, chronic rejection, or ITBL (P = 0.013).
Conclusion:
At median follow‐up of 568 days, TPE in combination with IVIg and ECP appears to protect the graft from AMR in ABO‐i liver transplantation. Continued patient enrollment will allow validation of these preliminary observations or the opportunity to devise newer AMR‐avoidance policies. J. Clin. Apheresis 2008. © 2008 Wiley‐Liss, Inc.</description><identifier>ISSN: 0733-2459</identifier><identifier>EISSN: 1098-1101</identifier><identifier>DOI: 10.1002/jca.20156</identifier><identifier>PMID: 18186527</identifier><language>eng</language><publisher>Hoboken: Wiley Subscription Services, Inc., A Wiley Company</publisher><subject>ABO Blood-Group System ; ABO-incompatible ; Adult ; antibody-mediated rejection ; Blood Group Incompatibility ; Combined Modality Therapy ; ECP ; Female ; Graft Rejection - therapy ; Humans ; Immunoglobulins - therapeutic use ; Immunologic Factors ; IVIG ; Liver Transplantation ; Male ; Middle Aged ; Photopheresis ; Plasmapheresis ; Retrospective Studies</subject><ispartof>Journal of clinical apheresis, 2008, Vol.23 (2), p.55-62</ispartof><rights>Copyright © 2008 Wiley‐Liss, Inc.</rights><rights>(c) 2008 Wiley-Liss, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4276-1071fa147ff2d28a3b8484949d6ec01b7b893e848a46d78238faf211e25f49433</citedby><cites>FETCH-LOGICAL-c4276-1071fa147ff2d28a3b8484949d6ec01b7b893e848a46d78238faf211e25f49433</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fjca.20156$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fjca.20156$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,4024,27923,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18186527$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Urbani, Lucio</creatorcontrib><creatorcontrib>Mazzoni, Alessandro</creatorcontrib><creatorcontrib>Bianco, Irene</creatorcontrib><creatorcontrib>Grazzini, Tiziana</creatorcontrib><creatorcontrib>De Simone, Paolo</creatorcontrib><creatorcontrib>Catalano, Gabriele</creatorcontrib><creatorcontrib>Montin, Umberto</creatorcontrib><creatorcontrib>Petruccelli, Stefania</creatorcontrib><creatorcontrib>Morelli, Luca</creatorcontrib><creatorcontrib>Campani, Daniela</creatorcontrib><creatorcontrib>Pollina, Luca</creatorcontrib><creatorcontrib>Biancofiore, Gianni</creatorcontrib><creatorcontrib>Bindi, Lucia</creatorcontrib><creatorcontrib>Tascini, Carlo</creatorcontrib><creatorcontrib>Menichetti, Francesco</creatorcontrib><creatorcontrib>Scatena, Fabrizio</creatorcontrib><creatorcontrib>Filipponi, Franco</creatorcontrib><title>The role of immunomodulation in ABO-incompatible adult liver transplant recipients</title><title>Journal of clinical apheresis</title><addtitle>J. Clin. Apheresis</addtitle><description>Background:
ABO‐incompatible (ABO‐i) liver transplantation (LT) is a high‐risk procedure due to the potential for antibody‐mediated rejection (AMR) and cell‐mediated rejection. The aim of the current report is to illustrate the results of a retrospective comparison study on the use of immunomodulation with therapeutic plasma exchange (TPE) associated to high‐dose immunoglobulins (IVIg) and extracorporeal photopheresis (ECP) in ABO‐i adult LT patients.
Patients and methods:
Between January 1996 and December 2005, 19 patients underwent ABO‐i LT. The study was designed for a comparison between two groups of ABO‐i LT. Group 1 (control group) consisted of 11 patients treated with TPE only. Group 2 (study group) included eight patients treated with TPE and IVIg. Moreover, all Group 2 patients received acute rejection prophylaxis with ECP.
Results:
The graft survival at 6, 12, and 18 months was 63.6, 54.4, and 45.5% for Group 1 vs. 87.5, 87.5, and 87.5% for Group 2 (P ≤ 0.001). In Group 1 there were 3(27.3%) cases of AMR; 5 (45.4%) biopsy‐proven acute rejections (BPAR); 1 (9.1%) chronic rejection and 3 (27.3%) ischemic‐type biliary lesions (ITBL). In Group 2 there were no cases of AMR, BPAR, chronic rejection, or ITBL (P = 0.013).
Conclusion:
At median follow‐up of 568 days, TPE in combination with IVIg and ECP appears to protect the graft from AMR in ABO‐i liver transplantation. Continued patient enrollment will allow validation of these preliminary observations or the opportunity to devise newer AMR‐avoidance policies. J. Clin. Apheresis 2008. © 2008 Wiley‐Liss, Inc.</description><subject>ABO Blood-Group System</subject><subject>ABO-incompatible</subject><subject>Adult</subject><subject>antibody-mediated rejection</subject><subject>Blood Group Incompatibility</subject><subject>Combined Modality Therapy</subject><subject>ECP</subject><subject>Female</subject><subject>Graft Rejection - therapy</subject><subject>Humans</subject><subject>Immunoglobulins - therapeutic use</subject><subject>Immunologic Factors</subject><subject>IVIG</subject><subject>Liver Transplantation</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Photopheresis</subject><subject>Plasmapheresis</subject><subject>Retrospective Studies</subject><issn>0733-2459</issn><issn>1098-1101</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kMtOwzAQRS0EglJY8AMoKyQWAb8SO8tS0ZYKgQRFLC0nsYUhiYOdAP17DCmwYjXSzLlXowPAEYJnCEJ8_lzIMwxRkm6BEYIZjxGCaBuMICMkxjTJ9sC-988QwiwjyS7YQxzxNMFsBO5WTypytlKR1ZGp676xtS37SnbGNpFposnFbWyawtZtWOWBk-HaRZV5Uy7qnGx8W8mmi5wqTGtU0_kDsKNl5dXhZo7Bw-xyNV3E17fzq-nkOi4oZmmMIENaIsq0xiXmkuSccprRrExVAVHOcp4RFXaSpiXjmHAtNUZI4UQHjJAxOBl6W2dfe-U7URtfqCq8o2zvBYOUY0yyAJ4OYOGs905p0TpTS7cWCIovgSIIFN8CA3u8Ke3zWpV_5MZYAM4H4N1Uav1_k1hOJz-V8ZAwvlMfvwnpXkTKCEvE481cLG5m9xerJRUp-QSeQoi6</recordid><startdate>2008</startdate><enddate>2008</enddate><creator>Urbani, Lucio</creator><creator>Mazzoni, Alessandro</creator><creator>Bianco, Irene</creator><creator>Grazzini, Tiziana</creator><creator>De Simone, Paolo</creator><creator>Catalano, Gabriele</creator><creator>Montin, Umberto</creator><creator>Petruccelli, Stefania</creator><creator>Morelli, Luca</creator><creator>Campani, Daniela</creator><creator>Pollina, Luca</creator><creator>Biancofiore, Gianni</creator><creator>Bindi, Lucia</creator><creator>Tascini, Carlo</creator><creator>Menichetti, Francesco</creator><creator>Scatena, Fabrizio</creator><creator>Filipponi, Franco</creator><general>Wiley Subscription Services, Inc., A Wiley Company</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>2008</creationdate><title>The role of immunomodulation in ABO-incompatible adult liver transplant recipients</title><author>Urbani, Lucio ; Mazzoni, Alessandro ; Bianco, Irene ; Grazzini, Tiziana ; De Simone, Paolo ; Catalano, Gabriele ; Montin, Umberto ; Petruccelli, Stefania ; Morelli, Luca ; Campani, Daniela ; Pollina, Luca ; Biancofiore, Gianni ; Bindi, Lucia ; Tascini, Carlo ; Menichetti, Francesco ; Scatena, Fabrizio ; Filipponi, Franco</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4276-1071fa147ff2d28a3b8484949d6ec01b7b893e848a46d78238faf211e25f49433</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>ABO Blood-Group System</topic><topic>ABO-incompatible</topic><topic>Adult</topic><topic>antibody-mediated rejection</topic><topic>Blood Group Incompatibility</topic><topic>Combined Modality Therapy</topic><topic>ECP</topic><topic>Female</topic><topic>Graft Rejection - therapy</topic><topic>Humans</topic><topic>Immunoglobulins - therapeutic use</topic><topic>Immunologic Factors</topic><topic>IVIG</topic><topic>Liver Transplantation</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Photopheresis</topic><topic>Plasmapheresis</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Urbani, Lucio</creatorcontrib><creatorcontrib>Mazzoni, Alessandro</creatorcontrib><creatorcontrib>Bianco, Irene</creatorcontrib><creatorcontrib>Grazzini, Tiziana</creatorcontrib><creatorcontrib>De Simone, Paolo</creatorcontrib><creatorcontrib>Catalano, Gabriele</creatorcontrib><creatorcontrib>Montin, Umberto</creatorcontrib><creatorcontrib>Petruccelli, Stefania</creatorcontrib><creatorcontrib>Morelli, Luca</creatorcontrib><creatorcontrib>Campani, Daniela</creatorcontrib><creatorcontrib>Pollina, Luca</creatorcontrib><creatorcontrib>Biancofiore, Gianni</creatorcontrib><creatorcontrib>Bindi, Lucia</creatorcontrib><creatorcontrib>Tascini, Carlo</creatorcontrib><creatorcontrib>Menichetti, Francesco</creatorcontrib><creatorcontrib>Scatena, Fabrizio</creatorcontrib><creatorcontrib>Filipponi, Franco</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of clinical apheresis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Urbani, Lucio</au><au>Mazzoni, Alessandro</au><au>Bianco, Irene</au><au>Grazzini, Tiziana</au><au>De Simone, Paolo</au><au>Catalano, Gabriele</au><au>Montin, Umberto</au><au>Petruccelli, Stefania</au><au>Morelli, Luca</au><au>Campani, Daniela</au><au>Pollina, Luca</au><au>Biancofiore, Gianni</au><au>Bindi, Lucia</au><au>Tascini, Carlo</au><au>Menichetti, Francesco</au><au>Scatena, Fabrizio</au><au>Filipponi, Franco</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The role of immunomodulation in ABO-incompatible adult liver transplant recipients</atitle><jtitle>Journal of clinical apheresis</jtitle><addtitle>J. Clin. Apheresis</addtitle><date>2008</date><risdate>2008</risdate><volume>23</volume><issue>2</issue><spage>55</spage><epage>62</epage><pages>55-62</pages><issn>0733-2459</issn><eissn>1098-1101</eissn><abstract>Background:
ABO‐incompatible (ABO‐i) liver transplantation (LT) is a high‐risk procedure due to the potential for antibody‐mediated rejection (AMR) and cell‐mediated rejection. The aim of the current report is to illustrate the results of a retrospective comparison study on the use of immunomodulation with therapeutic plasma exchange (TPE) associated to high‐dose immunoglobulins (IVIg) and extracorporeal photopheresis (ECP) in ABO‐i adult LT patients.
Patients and methods:
Between January 1996 and December 2005, 19 patients underwent ABO‐i LT. The study was designed for a comparison between two groups of ABO‐i LT. Group 1 (control group) consisted of 11 patients treated with TPE only. Group 2 (study group) included eight patients treated with TPE and IVIg. Moreover, all Group 2 patients received acute rejection prophylaxis with ECP.
Results:
The graft survival at 6, 12, and 18 months was 63.6, 54.4, and 45.5% for Group 1 vs. 87.5, 87.5, and 87.5% for Group 2 (P ≤ 0.001). In Group 1 there were 3(27.3%) cases of AMR; 5 (45.4%) biopsy‐proven acute rejections (BPAR); 1 (9.1%) chronic rejection and 3 (27.3%) ischemic‐type biliary lesions (ITBL). In Group 2 there were no cases of AMR, BPAR, chronic rejection, or ITBL (P = 0.013).
Conclusion:
At median follow‐up of 568 days, TPE in combination with IVIg and ECP appears to protect the graft from AMR in ABO‐i liver transplantation. Continued patient enrollment will allow validation of these preliminary observations or the opportunity to devise newer AMR‐avoidance policies. J. Clin. Apheresis 2008. © 2008 Wiley‐Liss, Inc.</abstract><cop>Hoboken</cop><pub>Wiley Subscription Services, Inc., A Wiley Company</pub><pmid>18186527</pmid><doi>10.1002/jca.20156</doi><tpages>8</tpages></addata></record> |
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| source | Wiley Online Library - AutoHoldings Journals; MEDLINE |
| subjects | ABO Blood-Group System ABO-incompatible Adult antibody-mediated rejection Blood Group Incompatibility Combined Modality Therapy ECP Female Graft Rejection - therapy Humans Immunoglobulins - therapeutic use Immunologic Factors IVIG Liver Transplantation Male Middle Aged Photopheresis Plasmapheresis Retrospective Studies |
| title | The role of immunomodulation in ABO-incompatible adult liver transplant recipients |
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