(P-TA-11) Therapeutic Plasma Exchange And Pancreas Transplantation

Sunday, October 20, 2024

12:00 PM - 1:00 PM

Presenting Author(s)

EM

Erica Mioto Braz Merchan, n/a (she/her/hers)

Hospital Samaritano Blood Bank and Transfusion Service- Grupo Vita
São Paulo, Sao Paulo, Brazil

Background/Case Studies: Diabetes is the pandemic disease of the modern era and the number of people diagnosed with diabetes has risen. Pancreas transplant (PT) could be considered an opportunity to maintain normoglycemia with full insulin independence and it is the only mode of therapy for most end-stage organ failure affecting pancreas. Acute rejection is an important risk factor for long-term graft loss because of chronic rejection and the formation of DSAs. Despite the vast literature available for the treatment of patients with kidney transplant rejection, there are few publications available for PT, as we can see in The Guidelines on the Use of Therapeutic Apheresis, ninth special issue 2023, that considered PT for the development of a new fact sheet but did not yet have sufficient published evidence to meet the criteria. Considering this, this study aimed to assess the role of therapeutic plasma exchange (TPE) in patients with acute rejection.

Study

Design/Methods: Our TPE protocol describes the therapeutic management and evolution of a series of 07 patients admitted and followed in the transplant unit of Hospital Leforte Liberdade in São Paulo, from April 2023 to April 2024, diagnosed with PT and humoral rejection. Patient characteristics, median age was 40 years (32–48). The diagnostic confirmation was performed by pancreas biopsy following the Banff criteria Banff (score 2 and 3). There were 3 categories of PT modalities (1 pancreas transplant alone and 1 retransplant of pancreas transplant alone, 2 pancreas after kidney transplant, 4 simultaneous pancreas kidney transplant). The underlying pancreatic disease and treatment varied from case to case. In all cases, the therapeutic approach included TPE as first or second choice, in combination with immunosuppressive therapy. Immunosuppressive agents such as thymoglobulin, methylprednisolone pulse, and immunoglobulin were used. Other criteria’s as C4d and DSA were used to indicate the patients for TPE. In relation to C4d (2 were 100% positive, one 50%, one 40%, one 10% and one negative); DSA (all patients were class II positive).

Results/Findings: Five procedures per patient were performed, with exchange of one plasma volume. Four patients undergoing combined treatment, immunosuppressive and plasmapheresis, showed recovery of pancreatic function demonstrated by graft maintenance and decrease of enzymes. One patient experienced a new deterioration in graft function requiring an additional 5 procedures with partial response.

Conclusions:

Plasmapheresis appears to be an important component of rejection treatment regimens to reduce donor-specific antibodies and increase graft survival chances. New studies should be conducted to determine the frequency and number of procedures and the best combination of immunosuppression for patients.