Protein A immunoadsorption therapy in the highly sensitized kidney transplant candidates.

Background: Sensitization in transplant candidates increases risk of irreversible immunologic injury of graft in the early period postoperatively. Elimination of anti-human leukocyte antigen (HLA) antibodies using protein A immunoadsorption (IA) might benefit these patients.
Methods: Protein A IA was used in 21 patients with high panel reactive antibody (PRA). The patients had IA 1 - 6 times (median 5 times) with the interval period was 2 - 5 days (median 2.5 days).
Results: Total 67 IA procedures were carried out smoothly in all patients. IA treatment reduced PRA I (pre (31.4 ± 3.8)% vs. post (24.4 ± 3.4)%, P < 0.01) and II (pre (37.1 ± 4.3)% vs. post (34.1 ± 3.9)%, P < 0.01). However, PRA did not change in some patients after the treatment. The serum immunoglobulin (IgG, IgM and IgA) and complement C3, C4 level were decreased significantly. Hemoglobin and albumin levels were slightly decreased associated with IA procedures. Flu-like symptoms were observed in a few of cases during the procedure but generally mild and transient.
Conclusion: Protein A IA is capable to efficiently remove serum immunoglobulin and complement, reduce HLA class I and class II PRA in high sensitized transplant candidates, which is likely to benefit the kidney transplantation in these patients.