Antibody-removal therapies for de novo DSA in pediatric intestinal recipients: Why, when, and how? A single-center experience

• DOI: 10.3389/fped.2022.1074577
• Publication Date: 2023-02-02T15:19:23Z
• Authors: María Lasa-Lázaro; Esther Ramos-Boluda; Esther Mancebo; María José Castro...; Rocío González-Sa...; Javier Serradilla; Ane Miren Andrés-...; Francisco Hernánd...; Estela Paz-Artal; Paloma Talayero
• Keywords: Plasmapheresis; Single Center; Concomitant; Donor-Specific Antibodies

Background Donor-specific anti-HLA antibodies (DSA) impact negatively on the outcome of intestinal grafts. Although use antibody-removal therapies (ART) is becoming more frequent in last few years, issues regarding their timing and effectiveness remain under discussion. Methods In present study, we report our experience with eight ART procedures (based plasmapheresis, intravenous immunoglobulin, rituximab) pediatric multivisceral transplants de novo DSA (dnDSA). Results were performed when dnDSA appeared two contexts: (1) concomitant rejection (acute or chronic) (2) without any other clinical symptom. Complete removal was observed seven out patients, showing an 88%. group treated for symptoms, success rate 100%, complete afterward. A shorter time between detection performance as a significant factor therapy ( p = 0.0002). against HLA-A DQ alleles most resistant to ART, whereas anti-DR sensitive. addition, 8-year allograft survival recipients undergoing similar that those DSA, being significantly lower non-treated DSA-positive 0.013). Conclusion The results confirm terms encourage its early even absence symptoms.