Clinical observation and nursing care of sensitized kidney transplant recipients treated with combined desensitization based on double-column protein A immunoadsorption for clearing HLA antibodies
CHEN Xiaofei1, WANG Yuxia1, WANG Meijia1, YU Boguang2, DONG Peijian2, FENG Zhixian1
1.Department of Nephrology, Shulan (Hangzhou) Hospital, Zhejiang Shuren University Shulan International Medical College, Hangzhou 310000, China; 2.Guangdong Provincial Key Laboratory of Hemoadsorption Technology, Guangzhou 510660, China
CHEN Xiaofei,WANG Yuxia,WANG Meijia, et al. Clinical observation and nursing care of sensitized kidney transplant recipients treated with combined desensitization based on double-column protein A immunoadsorption for clearing HLA antibodies[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2023, 53(8): 651-656.
Abstract：Objective: To investigate the clearance effects of desensitization therapy on human leukocyte antigen (HLA) antibodies so as to provide a reference formulation of nursing practice on immunoadsorption therapy with double-column. Methods: Totally 48 kidney transplant recipients who received preoperative/postoperative desensitization therapy based on Protein A Immunoadsorption (PA-IA) therapy in combination with drug therapy in Shulan (Hangzhou) Hospital from July 2017 to July 2022 were enrolled, of whom 27 treated with double-column and 21 with single-column. For the patients with double-column treatment the pre-treatment mean fluorescence intensity (MFI) of 1 324 HLA antibody specificities (MFI > 2 000) and the post-treatment MFI of the corresponding antibody specificities (after 1, 4, 7, and 10 sessions) were recorded for analysis of the changes in antibody level reduction for the different antibody classes and MFI ranges. The operation procedure of double column immunoadsorption and nursing measures were recorded and summarized. The age, weight, regenerated plasma volume, treatment time and anticoagulant dosage of the two groups were compared. Results: There was no statistically significant difference in the baseline data between the two groups (P>0.05), the regenerated plasma volume of two-column group is larger than that of single-column (P<0.05). Compared with single-column therapy, double-column therapy significantly reduced extracorporeal circulation time (P<0.001) and anticoagulant dosage (P<0.001). After 10 sessions of two-column therapy, the MFI of class I antibodies decreased from 8 298.6 to 3 196.2 (reduction of 66.80%), while the MFI of class II antibodies decreased from 13 521.1 to 2 773.3 (reduction of 71.14%). The clearance effect of PA-IA therapy were was better on strongly positive (MFI > 10 000) class II antibodies than on strongly positive class I antibodies, showing a respective reduction (P=0.015) of 62.59% (25.17%, 91.04%) and 45.13% (32.70%, 73.94%). Conclusion: Double-column immunoadsorption system can remove effectively HLA antibody, significantly reduced extracorporeal circulation time and anticoagulant dosage and thus improve medical security.
