Prognostic tools to assess candidacy for and efficacy of antibody-removal therapy

David F. Pinelli*, Andrea A. Zachary, John J. Friedewald, David W. Gjertson, Michelle A. Evans, Erik N. Chatroop, Mary S. Leffell, Ashley A. Vo, Stanley C. Jordan, Robert A. Montgomery, Anat R. Tambur

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Currently, the ability to predict or monitor the efficacy of HLA antibody–removal therapies is deficient. We previously reported that titration studies are a consistent and accurate means of assessing antibody strength. To test whether titration studies can also predict which patients are better candidates for desensitization, we studied 38 patients from 3 centers (29 receiving plasmapheresis/low-dose intravenous immunoglobulin [IVIg]; 9 patients receiving high-dose IVIg). For patients undergoing plasmapheresis/low-dose IVIg, antibody titer reduction correlated with number of treatment cycles for both class I and II antibodies but only up to approximately 4 cycles. Reduction in titer slowed with additional cycles, suggesting a limit to the efficacy of this approach. Furthermore, initial titer (predesensitization) can guide the selection of candidates for successful antibody-removal treatment. In our experience, patients with antibodies at an initial titer >1:512 could not be reduced to the goal of a negative lymphocyte crossmatch, corresponding to a 1:16 titer, despite a significant increase in the number of treatment cycles. Change in mean fluorescence intensity (MFI) value did not correlate with success of treatment if initial MFI values were >10 000, likely due to single antigen bead saturation. Overall, we present a potential prognostic tool to predict candidacy and a monitoring tool to assess efficacy of desensitization treatment.

Original languageEnglish (US)
Pages (from-to)381-390
Number of pages10
JournalAmerican Journal of Transplantation
Issue number2
StatePublished - Feb 2019


  • alloantibody
  • clinical research/practice
  • desensitization
  • histocompatibility
  • immunosuppression/immune modulation
  • intravenous immunoglobulin/IVIg
  • kidney transplantation/nephrology
  • plasmapheresis/plasma exchange
  • rejection: antibody-mediated (ABMR)
  • translational research/science

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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