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1.
Diab Vasc Dis Res ; 19(6): 14791641221131788, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36357361

RESUMO

AIMS: Rheopheresis is an extracorporeal haematotherapy that improves haemorheological status by filtering proteins that enhance blood viscosity. It also has anti-inflammatory effects by removing inflammatory cytokines. Our study aims to examine the effects of rheopheresis on the endothelial status in diabetic lower extremity ulceration. METHODS: In vitro experiments were performed in a HUVEC model to mimic hyperglycaemic stress. We determined the changes in gene expression levels of IL-6, IL-8, TNF-alpha, endothelin convertase enzyme, ET-1, and NO synthase, as well as the ROS and intracellular GSH levels upon hyperglycaemia. In in vivo studies, two rheopheresis procedures were performed on seven patients with diabetic lower extremity ulceration with hyperviscosity, and we measured the changes in plasma concentrations of ET-1, TXB2, SOD enzyme activity, and extracellular components of the glutathione pool depending on treatments. RESULTS: Our results showed that hyperglycaemia increases endothelial expression of inflammatory cytokines, ET-1, and endothelin convertase enzyme, while NO synthase was decreased. As a result of rheopheresis, we observed decreased ET-1 and TXB2 concentrations in the plasma and beneficial changes in the parameters of the glutathione pool. CONCLUSION: To summarize our results, hyperglycaemia-induced oxidative stress and endothelial inflammation can be moderated by rheopheresis in diabetic lower extremity ulceration with hyperviscosity.


Assuntos
Diabetes Mellitus , Hiperglicemia , Doenças Vasculares , Humanos , Hiperglicemia/terapia , Estresse Oxidativo , Glutationa , Óxido Nítrico Sintase , Plasmaferese/métodos , Extremidade Inferior , Citocinas
2.
Hematology ; 27(1): 1217-1222, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36367991

RESUMO

OBJECTIVES: This study evaluates the efficacy and safety of plasmapheresis without plasma transfusion tandem with chemotherapy in treating multiple myeloma (MM). METHOD: This retrospective study involves seventy-two patients, newly diagnosed with multiple myeloma, divided into two groups; one with plasmapheresis without plasma transfusion tandem with the chemotherapy group (Trial group), while the second was chemotherapy group (Control group). The levels of Plasma Globulin, ß2-microglobulin, Creatinine, Vascular endothelial growth factor (VEGF), and IL-6 were monitored after plasmapheresis, at initial diagnosis, and after four chemotherapy courses. Overall response rate of groups after four courses of chemotherapy was analyzed, and the adverse events were recorded. RESULTS AND DISCUSSION: The baseline data showed that sixty-seven percent of patients were at the ISS III stage and showed more severe renal insufficiency in the Trial group. The Plasma Globulin, ß2-microglobulin, VEGF and IL-6 levels were significantly different between the two groups during the initial diagnosis. After three times plasmapheresis, Plasma Globulin, ß2-microglobulin, VEGF, and IL-6 were significantly reduced in the plasmapheresis group. The Creatinine levels were also lowered, but the differences were not statistically significant. After four courses of chemotherapy, the levels of VEGF and IL-6 in the two groups were significantly reduced than the initial diagnosis; the differences were statistically considerable. No adverse events were found in the trial group as compared to the control group. CONCLUSION: Plasmapheresis reduces Globulin, ß2-microglobulin, serum VEGF and IL-6 levels in MM, improves renal functions, and releases some patients from dialysis dependence.


Assuntos
Mieloma Múltiplo , Humanos , Mieloma Múltiplo/tratamento farmacológico , Fator A de Crescimento do Endotélio Vascular/uso terapêutico , Creatinina , Estudos Retrospectivos , Interleucina-6 , Transfusão de Componentes Sanguíneos , Plasma , Plasmaferese
3.
J Clin Apher ; 37(5): 476-488, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36195967

RESUMO

INTRODUCTION: Certain patients require simultaneous lipoprotein apheresis (LA) and intermittent hemodialysis (HD). Instead of undergoing 2 consecutive treatment sessions, a double filtration plasmapheresis (DFPP) and HD tandem procedure could be offered to reduce treatment times and costs. Our study evaluated the performance, safety and cost of this tandem procedure. MATERIAL AND METHODS: Three patients underwent 168 HD and DFPP tandem sessions in a tertiary center from August 2018 to November 2020, using a Fresenius 5008 generator for HD and an InfomedHF440 for DFPP. The system's efficacy was assessed by lipid subtraction performance for DFPP. Efficacy of 2 blood line connection configurations (parallel or sequential) was compared in terms of Kt/V and matched against an HD control session for each patient. Clinical and biological safety and the differential cost between tandem and consecutive procedures were evaluated. RESULTS: Throughout the tandem sessions, DFPP lasted 85 to 120 minutes, overlapping the 240-minute HD. Blood flow for HD and Kt/V were significantly lower during the tandem procedure with a parallel configuration compared to sequential or control paired HD. DFPP efficacy was comparable between all groups: over 60% reduction in cholesterol and over 50% for triglycerides. Symptomatic hypotension depended on the patients, not the procedure. The tandem procedure revealed an acceptable benefit-cost ratio. CONCLUSION: HD-DFPP tandem with a sequential blood line connecting system (derivation installed on the HD venous line) is effective and well-tolerated with a good cost-benefit ratio. Tandem reduces hospitalization and treatment session times and can be offered to patients requiring simultaneous HD and DFPP.


Assuntos
Plasmaferese , Diálise Renal , Análise Custo-Benefício , Humanos , Lipoproteínas , Plasmaferese/métodos , Diálise Renal/métodos , Triglicerídeos
4.
J Clin Pharm Ther ; 47(11): 1885-1887, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36205441

RESUMO

WHAT IS KNOWN AND OBJECTIVE: Severe hypertriglyceridemia (HTG) can cause acute pancreatitis (AP). CASE SUMMARY: We report a patient with acute lymphoblastic leukaemia who received long-term intravenous parenteral nutrition solution without monitoring of the serum triglyceride (TG) level, which resulted in fat overload syndrome and HTG-AP. WHAT IS NEW AND CONCLUSION: Double filtration plasmapheresis was performed to eliminate the TGs and treat the AP.


Assuntos
Hipertrigliceridemia , Pancreatite , Humanos , Pancreatite/terapia , Doença Aguda , Hipertrigliceridemia/complicações , Hipertrigliceridemia/terapia , Plasmaferese/métodos , Triglicerídeos
5.
Front Endocrinol (Lausanne) ; 13: 997296, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36157458

RESUMO

Type B insulin resistance syndrome (TBIR) is a rare disease characterized by refractory diabetes due to severe insulin resistance caused by anti-insulin receptor autoantibodies, and a standard treatment regimen for TBIR has not been established, leading to therapeutic difficulties and high mortality. Since TBIR is known to be associated with autoimmune diseases such as systemic lupus erythematosus (SLE), glucocorticoids are often used as key immunosuppressive agents. However, glucocorticoids have the potential to exacerbate the pathophysiology of TBIR by worsening insulin sensitivity, which leads to hyperglycemia and muscle wasting. Here, we report a case history of a 66-year-old man who was diagnosed as having TBIR in combination with SLE and Sjögren's syndrome with marked hyperglycemia, ketosis, and muscle wasting. He was successfully treated with combination therapy of double-filtration plasmapheresis (DFPP) and administration of the anti-CD20 monoclonal antibody rituximab without induction of glucocorticoid therapy while using a sensor-augmented insulin pump (SAP) to prevent hypoglycemia. Remission of diabetes was achieved without severe hypoglycemic events and his circulating insulin receptor antibodies became negative after seven months of initiation of these treatments. Based on the successful clinical courses of this case, our report suggests the possibility of an effective therapeutic regimen with DFPP and rituximab under the condition of the use of an SAP for a patient with TBIR without induction of glucocorticoids.


Assuntos
Doenças Autoimunes , Diabetes Mellitus , Hiperglicemia , Resistência à Insulina , Lúpus Eritematoso Sistêmico , Idoso , Anticorpos Monoclonais/uso terapêutico , Autoanticorpos , Diabetes Mellitus/tratamento farmacológico , Glucocorticoides/uso terapêutico , Humanos , Hiperglicemia/complicações , Hipoglicemiantes/uso terapêutico , Imunossupressores/uso terapêutico , Lúpus Eritematoso Sistêmico/complicações , Masculino , Plasmaferese , Rituximab/uso terapêutico
6.
PLoS One ; 17(9): e0274959, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36137166

RESUMO

Recurrence of proteinuria after kidney transplantation in primary focal segmental glomerulosclerosis (FSGS) is unpredictable. Several putative circulating permeability factors (CPFs) have been suggested, but none have been validated. A clinically relevant experimental model is required that demonstrates the presence of CPF(s) in patient material, to study CPF(s) and possibly predict recurrence in patients. We aimed to develop a FSGS-prone Thy-1.1 transgenic mouse model with accelerated proteinuria after injection of samples from patients with FSGS. The Thy-1.1 transgene was backcrossed into 5 mouse strains. The age of onset and severity of spontaneous proteinuria varied between the different genetic backgrounds. 129X1/SvThy-1.1 and 129S2/SvPasThy-1.1 mice displayed proteinuria at 4 weeks, whereas Balb/cThy-1.1 and C57BL/6JThy-1.1 mice developed proteinuria from 6 weeks, and were used further. We determined the maximum protein dose that could be injected without causing protein overload in each background. Balb/cThy-1.1 and C57BL/6JThy-1.1 males and females were injected with presumably CPF-containing plasmapheresis effluent from 6 FSGS patients, which induced albuminuria particularly in Balb/cThy-1.1 males. Unfortunately, no response could be detected when using sera instead of plasmapheresis effluent, serum being more clinically relevant in the context of predicting FSGS recurrence. Considering the differences between responses elicited by serum and plasmapheresis effluent, simultaneously collected serum, plasma, and plasmapheresis effluent were tested. Whereas we could detect responses using a validated in vitro model, none of these presumably CPF-containing samples induced proteinuria in Balb/cThy-1.1 males. Thus, we have extensively tested the Thy-1.1 mouse model on different genetic backgrounds with proteinuria after injection of FSGS patient material as clinically relevant readout. The Balb/cThy-1.1 male mouse strain demonstrated the most promising results, but to detect CPF activity in FSGS serum e.g. prior to kidney transplantation, this strain clearly lacks sensitivity and is therefore not yet clinically applicable. It could, however, still be used as research tool to study CPFs in patient samples that did induce proteinuria.


Assuntos
Glomerulosclerose Segmentar e Focal , Animais , Feminino , Glomerulosclerose Segmentar e Focal/genética , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Permeabilidade , Plasmaferese , Proteinúria/etiologia , Recidiva
7.
Medicina (B Aires) ; 82 Suppl 3: 82-88, 2022 Aug 30.
Artigo em Espanhol | MEDLINE | ID: mdl-36054864

RESUMO

Guillain-Barré syndrome (GBS) is characterized by rapidly progressive and generally ascending symmetrical muscle weakness, accompanied by decreased or absent osteotendinous reflexes. The inflammatory process may affect the myelin or the axon. There are 4 clinical forms of GBS: 1) acute inflammatory demyelinating polyradiculoneuropathy, 2) acute motor axonal neuropathy, 3) acute sensory and motor axonal neuropathy, and 4) the Miller-Fisher variant, which is characterized by ophthalmoplegia, ataxia and areflexia, with little muscle weakness. Diagnosis is based on the albumin-cytological dissociation observed at the end of the first week after the onset of symptoms and may persist until the third week, as well as on the specific neurophysiological alterations of each clinical form. The treatment of GBS will depend on the degree of severity, if the patient presents grade IV or less according to the Paradiso scale, it will be treated with Ig IV, if it presents grade V, the use of plasmapheresis and/or immunoadbosorption is recommended. In severe axonal cases, the use of corticosteroid bolus is recommended in initial stages. There is a clinical picture that overlaps GBS and chronic demyelinating polyneuropathy related to antibodies against neurophysin and contactin, in this case the appropriate therapy is rituximab.


El síndrome de Guillain-Barré (SGB) se caracteriza por debilidad muscular simétrica rápidamente progresiva y generalmente ascendente, acompañada de disminución o ausencia de reflejos osteotendinosos. El proceso inflamatorio puede afectar a la mielina o al axón. Existen 4 formas clínicas de SGB: 1) polirradiculoneuropatía desmielinizante inflamatoria aguda, 2) neuropatía axonal motora aguda, 3) neuropatía axonal sensitiva y motora aguda, y 4) la variante Miller-Fisher, que se caracteriza por oftalmoplejía, ataxia y arreflexia, con escasa debilidad muscular. El diagnóstico se basa en la disociación albúmino-citológica que se observa a final de la primera semana del inicio de los síntomas y puede persistir hasta la tercera semana, así como en las alteraciones neurofisiológicas específicas de cada forma clínica. El tratamiento el SGB, dependerá de la gravedad, si el paciente presenta grado IV o menor según la escala de Paradiso, se tratará con Ig IV, si presenta grado V, se recomienda el uso de plasmaféresis y/o inmunoadbosorción. En los casos axonales graves se recomienda el uso de bolus de corticoides en etapas iniciales. Existe un cuadro clínico que solapa SGB y polineuropatía desmielinizante crónica relacionado con anticuerpos contra neurofisina y contactina, en este caso la terapia adecuada es rituximab.


Assuntos
Síndrome de Guillain-Barré , Debilidade Muscular , Síndrome de Guillain-Barré/diagnóstico , Síndrome de Guillain-Barré/tratamento farmacológico , Humanos , Debilidade Muscular/terapia , Plasmaferese
8.
J Clin Apher ; 37(5): 522-526, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36151906

RESUMO

Brucellosis is a multisystemic disease that can present with multiple signs and symptoms. Rarely, brucellosis can manifest as neurobrucellosis, with central or peripheral nervous system involvement. Guillain-Barré syndrome (GBS) is a post-infectious autoimmune disease that progresses rapidly, causing ascending muscle weakness, and is accompanied by areflexia/hyporeflexia. Regarding GBS etiology, it is thought to be an autoimmune disease, triggered by a previous bacterial or viral infection. There are a few Brucella-associated GBS case reports in the literature and in our opinion, only one of them is a pediatric patient. Herein we reported a case of GBS associated with neurobrucellosis, who was successfully treated with therapeutic plasmapheresis (TP) due to poor response to IVIG treatment.


Assuntos
Doenças Autoimunes , Brucelose , Síndrome de Guillain-Barré , Doenças Autoimunes/terapia , Brucelose/tratamento farmacológico , Brucelose/terapia , Criança , Síndrome de Guillain-Barré/complicações , Síndrome de Guillain-Barré/diagnóstico , Síndrome de Guillain-Barré/terapia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Plasmaferese/efeitos adversos
11.
Intensive Care Med ; 48(10): 1382-1396, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35960275

RESUMO

In this narrative review, we discuss the relevant issues of therapeutic plasma exchange (TPE) in critically ill patients. For many conditions, the optimal indication, device type, frequency, duration, type of replacement fluid and criteria for stopping TPE are uncertain. TPE is a potentially lifesaving but also invasive procedure with risk of adverse events and complications and requires close monitoring by experienced teams. In the intensive care unit (ICU), the indications for TPE can be divided into (1) absolute, well-established, and evidence-based, for which TPE is recognized as first-line therapy, (2) relative, for which TPE is a recognized second-line treatment (alone or combined) and (3) rescue therapy, where TPE is used with a limited or theoretical evidence base. New indications are emerging and ongoing knowledge gaps, notably regarding the use of TPE during critical illness, support the establishment of a TPE registry dedicated to intensive care medicine.


Assuntos
Unidades de Terapia Intensiva , Troca Plasmática , Estado Terminal/terapia , Humanos , Troca Plasmática/efeitos adversos , Troca Plasmática/métodos , Plasmaferese , Respiração Artificial , Estudos Retrospectivos
12.
BMC Neurol ; 22(1): 293, 2022 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-35931957

RESUMO

BACKGROUND: Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP), a rare disorder affecting young adults, causes gradual weakness of the limbs, areflexia and impaired sensory function. New CIDP phenotypes without pathogenic antibodies but with modified cell profiles have been described. Treatments include corticotherapy, intravenous immunoglobulins, and plasmapheresis but the latter's action mechanisms remain unclear. Plasmapheresis supposedly removes toxic agents like antibodies from plasma but it is uncertain whether it has an immune-modulating effect. Also, the refining mechanisms of the two main plasmapheresis techniques-single plasma exchange and double filtration plasmapheresis (DFPP) - are different and unclear. This study aims to compare the evolution of peripheral lymphocyte profiles in patients with CIDP according to their treatment (single centrifugation plasmapheresis or DFPP) to better grasp the action mechanisms of both techniques. METHOD: In this proof-of-concept, monocentric, prospective, Single-Case Experimental Design study, 5 patients are evaluated by alternating their treatment type (single plasma exchange or DFPP) for 6 courses of treatment after randomization to their first treatment type. Each course of treatment lasts 2-4 weeks. For single plasma exchange, 60 ml/kg plasma will be removed from the patient and replaced with albumin solutes, with a centrifugation method to avoid the immunological reaction caused by the membrane used with the filtration method. For DFPP, 60 ml/kg plasma will be removed from the patient with a plasma separator membrane, then processed via a fractionator membrane to remove molecules of a greater size than albumin before returning it to the patient. This technique requires no substitution solutes, only 20 g of albumin to replace what would normally be lost during a session. The primary outcome is the difference between the two plasmapheresis techniques in the variation of the TH1/TH17 ratio over the period D0H0-D0H3 and D0H0-D7. Secondary outcomes include the variation in lymphocyte subpopulations at each session and between therapeutic plasmapheresis techniques, the clinical evolution, tolerance and cost of treatments. DISCUSSION: Understanding the action mechanisms of single plasma exchange and DFPP will help us to offer the right treatment to each patient with CIPD according to efficacy, tolerance and cost. TRIAL REGISTRATION: ClinicalTrials.gov under the no. NCT04742374 and date of registration 10 December 2020.


Assuntos
Troca Plasmática , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica , Albuminas , Humanos , Linfócitos , Fenótipo , Plasmaferese/métodos , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/terapia , Estudo de Prova de Conceito , Estudos Prospectivos , Projetos de Pesquisa
13.
Medicine (Baltimore) ; 101(32): e29689, 2022 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-35960041

RESUMO

INTRODUCTION: Familial chylomicronemia syndrome (FCS) is a rare genetic disease. FCS usually manifests by the age of 10 years, and 25% of cases of FCS occur during infancy. Here we present a case of FCS in a male infant and summarize our experiences on the diagnosis and therapy of this case. PATIENT CONCERNS: A male infant aged 1 month and 8 days had recurrent hematochezia and hyperchylomicronemia. DIAGNOSIS: FCS based on symptoms and genetic test. INTERVENTIONS: Plasma exchange therapy. OUTCOMES: His development was normal with a good spirit and satisfactory weight gain, and no hematochezia occurred again. CONCLUSION: Genetic test is important for accurate diagnosis of FCS, and we identified a new mutation of lipoprotein lipase gene c.88C>A which conformed to autosomal recessive inheritance. Plasma exchange therapy can be applied to infants with FCS with low risk and good outcomes.


Assuntos
Hiperlipoproteinemia Tipo I , Testes Genéticos , Humanos , Hiperlipoproteinemia Tipo I/genética , Hiperlipoproteinemia Tipo I/terapia , Lactente , Masculino , Troca Plasmática , Plasmaferese
14.
Clin Lab ; 68(7)2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-35975533

RESUMO

BACKGROUND: Severe hypertriglyceridemia (sHTG) is an independent risk factor of atherosclerotic heart disease (ASHD) and acute pancreatitis (AP). The aim was to evaluate the efficacy and safety of DFPP in sHTG patients (TG > 1,000 mg/dL). METHODS: This was a prospective single-center study in which patients with severe symptomatic drug and diet refractory HTG were recruited. Peripheral venous access of upper extremities was used for DFPP. Blood flow rate was 100 - 120 mL/min and plasma separation rate was 800 - 1,000 mL/h. Plasma volume to treat in each case was calculated with the Kaplan formula. Anticoagulation was achieved by low molecular weight heparin. Treatment goal was triglyceride level decreased to normal (< 1.7 mmol/L). Epidemiological data, lipid, hematological parameters as well as side effects were evaluated before and after DFPP. RESULTS: Seven patients (6 males and 1 female) were consecutively enrolled to this trial. There was diabetes mellitus type 2 in four patients and obesity-associated nephropathy in one patient. The mean age was 42.5 years. The average TG level before plasmapheresis was 17.41 mmol/L (range 10.93 - 26.33 mmol/L). After one session, the levels of triglyceride, total cholesterol, LDL-c, HDL-c decreased significantly by 58.3%, 43.2%, 41.9%, 20.7%, respectively. The mean number of treatment sessions was 1.5 (range 1 - 3). DFPP was well-tolerated. Except for transient decrease of albumin, globulin and fibrinogen, liver and renal functions, hematological parameters did not change significantly. CONCLUSIONS: According to our own experience, DFPP may be used safely and effectively in sHTG patients at risk of acute coronary events and AP. However, further randomized controlled trials are necessary to explore the long-term effect.


Assuntos
Hiperlipidemias , Hipertrigliceridemia , Pancreatite , Doença Aguda , Adulto , Feminino , Filtração , Humanos , Hipertrigliceridemia/complicações , Hipertrigliceridemia/terapia , Masculino , Pancreatite/complicações , Projetos Piloto , Plasmaferese , Estudos Prospectivos , Triglicerídeos
15.
J Neurol Sci ; 441: 120368, 2022 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-35932547

RESUMO

INTRODUCTION: The treatment of Guillain-Barré Syndrome (GBS) with intravenous immunoglobulin (IVIg) or plasma exchange (PE) reduces time to clinical recovery. Although sometimes used in clinical practice, the benefit of a second treatment cycle is of unproven benefit. AIMS: Our aim was to compare GBS prognosis in patients treated with one or two cycles of IVIg or PE. METHODS: We selected patients with electrophysiological studies compatible with acute inflammatory demyelinating polyneuropathy or acute motor-sensory axonal neuropathy, from January 2018 to December 2020 in our hospital. Our primary outcome was any improvement in the Guillain-Barré Syndrome Disability Score (GBS-DS) at a mean of twelve weeks. We compared patients treated with one or two treatment cycles with a binary regression. RESULTS: We included twenty-six patients, 65.4% with the classical presentation and 30.8% were treated with two cycles. Patients treated with two cycles presented a higher basal GBS-DS (median 4; IQR 1-5) compared with the group of patients treated with one cycle (median 3; IQR 1-5), p = 0.01. The remaining basal characteristics were similar between groups. The two-cycle treatment regimen did not associate with an improvement in GBS-DS (OR 0.28, 95% CI 0.03-2.35, p = 0.24). Likewise there was no benefit in the need for intensive care unit (OR 2.0, 95% CI 0.37-10.92, p = 0.42) or mechanical invasive ventilation (OR 10.2, 95% CI 0.86-120.96, p = 0.66). DISCUSSION: Our analysis reinforces the recent literature data regarding the absence of benefit of two treatment cycles in patients with GBS.


Assuntos
Síndrome de Guillain-Barré , Imunoglobulinas Intravenosas , Síndrome de Guillain-Barré/tratamento farmacológico , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Troca Plasmática , Plasmaferese , Prognóstico
16.
Curr Opin Organ Transplant ; 27(5): 405-414, 2022 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-35950887

RESUMO

PURPOSE OF REVIEW: Antibody-mediated rejection (AMR) has emerged as the leading cause of late graft loss in kidney transplant recipients. Donor-specific antibodies are an independent risk factor for AMR and graft loss. However, not all donor-specific antibodies are pathogenic. AMR treatment is heterogeneous due to the lack of robust trials to support clinical decisions. This review provides an overview and comments on practical but relevant dilemmas physicians experience in managing kidney transplant recipients with AMR. RECENT FINDINGS: Active AMR with donor-specific antibodies may be treated with plasmapheresis, intravenous immunoglobulin and corticosteroids with additional therapies considered on a case-by-case basis. On the contrary, no treatment has been shown to be effective against chronic active AMR. Various biomarkers and prediction models to assess the individual risk of graft failure and response to rejection treatment show promise. SUMMARY: The ability to personalize management for a given kidney transplant recipient and identify treatments that will improve their long-term outcome remains a critical unmet need. Earlier identification of AMR with noninvasive biomarkers and prediction models to assess the individual risk of graft failure should be considered. Enrolling patients with AMR in clinical trials to assess novel therapeutic agents is highly encouraged.


Assuntos
Rejeição de Enxerto , Transplante de Rim , Anticorpos , Biomarcadores , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto , Humanos , Isoanticorpos , Transplante de Rim/efeitos adversos , Plasmaferese
18.
Int J Infect Dis ; 122: 1052-1055, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35908721

RESUMO

A novel condition named multisystem inflammatory syndrome has raised the alarm worldwide and is leading to severe illness and long-term effects in the post-COVID era. This condition includes infection with fever, abdominal symptoms, acute cardiac injury, and shock. It has similarities with severe forms of Kawasaki disease (KD). In this study, we present a case of a 20-year-old male patient with multisystem inflammatory syndrome associated with COVID-19 infection who was successfully treated with plasmapheresis, immunoglobulins, and steroids for 4 h/day without heparinization or ultrafiltration. Plasmapheresis represents a therapeutic option for KD in patients with all other therapeutic strategies that have failed. However, there is no evidence from controlled clinical trials confirming this option. In our case, plasmapheresis was beneficial in stabilizing and improving the patient's clinical condition. Given the pathophysiological and therapeutic similarities between KD and multisystem inflammatory syndrome, it could be considered a therapeutic option.


Assuntos
COVID-19 , Síndrome de Linfonodos Mucocutâneos , Corticosteroides/uso terapêutico , Adulto , COVID-19/terapia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Masculino , Plasmaferese , Síndrome de Resposta Inflamatória Sistêmica/complicações , Adulto Jovem
19.
Transplant Proc ; 54(6): 1632-1635, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35853766

RESUMO

BACKGROUND: Idiopathic focal segmental glomerulosclerosis is an important cause of kidney failure in adults, which is associated with a high risk of disease recurrence after transplantation. Plasmapheresis, rituximab, immunoadsorption, and high-dose cyclosporine are used to treat post-transplant recurrent focal segmental glomerulosclerosis (rFSGS). However, the response rate is variable, and few options remain for unresponsive patients. CASE REPORT: We present a 44-year-old man with an early post-transplant rFSGS. After peritransplant plasmapheresis, rituximab, and abatacept treatments failed, we employed ofatumumab. After 9 months without apparent benefit, we observed an unexpected partial remission thereafter, without severe side effects. Furthermore, remission has been sustained in 30-month follow-up. CONCLUSIONS: We believe ofatumumab can be considered an alternative for patients with plasmapheresis and rituximab-resistant post-transplant rFSGS.


Assuntos
Glomerulosclerose Segmentar e Focal , Transplante de Rim , Abatacepte/uso terapêutico , Adulto , Anticorpos Monoclonais Humanizados , Ciclosporina/uso terapêutico , Glomerulosclerose Segmentar e Focal/etiologia , Glomerulosclerose Segmentar e Focal/cirurgia , Humanos , Transplante de Rim/efeitos adversos , Masculino , Plasmaferese , Recidiva , Rituximab/uso terapêutico , Resultado do Tratamento
20.
Ren Fail ; 44(1): 1123-1129, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35820833

RESUMO

BACKGROUND: Anti-glomerular basement membrane (anti-GBM) disease is a rare but severe autoantibody-mediated immune disorder. The typical clinical presentation includes rapidly progressive glomerulonephritis and often concurrent pulmonary hemorrhage. The present study is aimed to investigate the therapeutic effects of rituximab either used alone or with other immunosuppressants. METHODS: Eight patients diagnosed with anti-GBM disease and treated with rituximab from 2014 to 2020 were retrospectively reviewed. RESULTS: Eight patients included 5 males and 3 females with a median age of 58.5 years. They all presented severe kidney injuries and 1 patient had lung hemorrhage. At diagnosis, the median of serum creatinine was 246 µmol/L (ranging from 91 to 850 µmol/L), with 3 patients requiring dialysis. All of them received corticosteroids and plasmapheresis. Rituximab was given as either standard four weekly doses or one pulse ranging from 100 to 600 mg. After a median follow-up of 34.5 months, kidney function was partially recovered or stabilized in 5/8 (62.5%) patients, free of dialysis. Anti-GBM antibodies remained undetected in all patients during follow-up. No severe adverse effect associated with rituximab was observed. CONCLUSION: Rituximab may be an alternative therapy in the treatment of patient with severe or refractory anti-GBM disease.


Assuntos
Doença Antimembrana Basal Glomerular , Pneumopatias , Doença Antimembrana Basal Glomerular/diagnóstico , Feminino , Hemorragia/complicações , Humanos , Pneumopatias/complicações , Masculino , Pessoa de Meia-Idade , Plasmaferese , Estudos Retrospectivos , Rituximab/uso terapêutico
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