Transplantation

“Preventive and therapeutic approach to Transplantation. From transport to ex-situ perfusion of organs intended for transplantation, to the removal of autoimmune complexes under conditions of rejection”.

The world of transplantation today
Organ transplantation is the gold standard therapy in patients with terminal organ failure. To date, the number of organs available for transplantation does not meet the actual demand and this has an impact on the mortality rate of patients on the waiting list.

Trapianto Uomo

It is therefore necessary to increase both the quality and safety of organs for transplantation and to increase the donor pool by recruiting marginal organs, using sub-optimal or compromised grafts (Extended Criteria Donor, ECD). It is therefore of crucial relevance to act on all stages of the process: from transportation to the way the organs are stored and treated, to the patient.

The Challenges of Transplantation

In order to meet the increased demand for organs available for transplantation and to cope with the growing waiting lists, the method of organ donation from incompatible donors has been introduced in recent years.

A kidney transplant in an AB0-incompatible subject results in immediate aggression by the recipient’s antibodies against the transplanted organ, leading to its rejection. In this case, it is therefore necessary to institute desensitizing treatment on the recipient, which starts approximately one month before the transplant. In particular, the recipient undergoes several sessions of plasmapheresis before the operation, with the aim of removing antibodies from the recipient’s blood, minimizing the risk of rejection in AB0 incompatible transplants. At the same time, three weeks before surgery, immunosuppressive drug therapy is started in the recipient, which is necessary to switch off the production of unwanted antibodies.

Molecules to be removed: IgG; IgM
Recommended therapies: Double filtration plasmapheresis (DFPP), Cascade Filtration (CF)

Following a transplant, all recipients are at risk of rejection of the transplanted organ: the recipient’s immune system recognizes the transplant as ‘non-self’ and this leads to activation of the immune system. The acute form of Antibody-Mediated Rejection (AMR) is a serious and potentially fatal clinic-pathological condition that can lead to rapid deterioration or even complete loss of the grafted organ following transplantation. Acute AMR mainly affects patients who are sensitized to their donors, i.e. those patients who, due to previous transplants, transfusions or pregnancies, possess ‘donor-specific antibodies’ (DSAs) that, by binding to antigens present on the donor organ, trigger uncontrolled activation of the complement system, causing an immune reaction that eventually damages the transplanted organ. There are also cases in which DSA antibodies develop de novo following organ transplantation and through various mechanisms, induce rejection. Treatment for this type of rejection involves the administration of immunosuppressive drugs, intravenous immunoglobulins, monoclonal antibodies and plasmapheresis, with the aim of quickly and effectively removing the antibodies involved in the rejection process.

Molecules to be removed: IgG
Recommended therapies: Double filtration plasmapheresis (DFPP), Cascade Filtration (CF)

Go to Plasmapher/Apherlungs system