Download PDF
Dialyse aktuell 2019; 23(08): 365-376
DOI: 10.1055/a-1011-5257
Original & Übersicht | Nephrologie
© Georg Thieme Verlag Stuttgart · New York

Immunadsorption und therapeutischer Plasmaaustausch

Welche Indikationen gibt es in Nephrologie und Neurologie?
Markus Tölle
1   CharitéCentrum13 – Schwerpunkt Nephrologie und Nierentransplantationszentrum, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin
› Author Affiliations
Further Information

Publication History

Publication Date:
11 October 2019 (online)

Also available at
    Permissions and Reprints

ZUSAMMENFASSUNG

Die zur Verfügung stehenden Aphereseformen sind wirksame und komplementäre Therapieoptionen u. a. für die Behandlung unterschiedlicher Autoimmunerkrankungen. Neben dem therapeutischen Plasmaaustausch bedeutet die Immunadsorption einen wichtigen Fortschritt unserer Behandlungsmöglichkeiten. In vielen Bereichen der Medizin, insbesondere in der Nephrologie und der Neurologie, konnten autoimmunologische Mechanismen als Auslöser zahlreicher Erkrankungen identifiziert werden. Bei vielen dieser Krankheitsbilder stellt die therapeutische Apherese eine wertvolle Therapieoption dar, insbesondere bei ausgeprägter klinischer Symptomatik oder bei therapieresistenten Verläufen. Im Rahmen dieses Artikels wird auf den Einsatz der therapeutischen Apherese bei den wichtigsten nephrologischen und neurologischen Erkrankungen eingegangen.

 

  • Literatur

  • 1 Stegmayr B, Ramlow W, Balogun RA. Beyond dialysis: current and emerging blood purification techniques. Semin Dial 2012; 25: 207-213 doi:10.1111/j.1525-139X.2011.01034.x
    CrossrefPubMedGoogle Scholar
  • 2 Hirasawa H, Sugai T, Oda S. et al. Efficacy and limitation of apheresis therapy in critical care. Ther Apher 1997; 1: 228-232
    CrossrefPubMedGoogle Scholar
  • 3 Huang Z, Wang SR, Su W, Liu JY. Removal of humoral mediators and the effect on the survival of septic patients by hemoperfusion with neutral microporous resin column. Ther Apher Dial 2010; 14: 596-602 doi:10.1111/j.1744-9987.2010.00825.x
    CrossrefPubMedGoogle Scholar
  • 4 Oishi K, Mimura-Kimura Y, Miyasho T. et al. Association between cytokine removal by polymyxin B hemoperfusion and improved pulmonary oxygenation in patients with acute exacerbation of idiopathic pulmonary fibrosis. Cytokine 2013; 61: 84-89 doi:10.1016/j.cyto.2012.08.032
    CrossrefPubMedGoogle Scholar
  • 5 Padmanabhan A, Connelly-Smith L, Aqui N. et al. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice – Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue. J Clin Apher 2019; 34: 171-354 doi:10.1002/jca.21705
    CrossrefPubMedGoogle Scholar
  • 6 Guyatt GH, Oxman AD, Vist GE. et al. GRADE Working Group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008; 336: 924-926 doi:10.1136/bmj.39489.470347.AD
    CrossrefPubMedGoogle Scholar
  • 7 Clark WF, Huang SS, Walsh MW. et al. Plasmapheresis for the treatment of kidney diseases. Kidney Int 2016; 90: 974-984 doi:10.1016/j.kint.2016.06.009
    CrossrefPubMedGoogle Scholar
  • 8 Bendapudi PK, Hurwitz S, Fry A. et al. Derivation and external validation of the PLASMIC score for rapid assessment of adults with thrombotic microangiopathies: a cohort study. Lancet Haematology 2017; 4: e157-e164 doi:10.1016/S2352-3026(17)30026-1
    PubMedGoogle Scholar
  • 9 Tsai HM, Lian EC. Antibodies to von Willebrand factor-cleaving protease in acute thrombotic thrombocytopenic purpura. N Engl J Med 1998; 339: 1585-1594 doi:10.1056/NEJM199811263392203
    CrossrefPubMedGoogle Scholar
  • 10 Ferrari S, Mudde GC, Rieger M. et al. IgG subclass distribution of anti-ADAMTS13 antibodies in patients with acquired thrombotic thrombocytopenic purpura. J Thromb Haemost 2009; 7: 1703-1710 doi:10.1111/j.1538-7836.2009.03568.x
    CrossrefPubMedGoogle Scholar
  • 11 Coppo P, Schwarzinger M, Buffet M. et al. Predictive features of severe acquired ADAMTS13 deficiency in idiopathic thrombotic microangiopathies: the French TMA reference center experience. PloS One 2010; 5: e10208 doi:10.1371/journal.pone.0010208
    CrossrefPubMedGoogle Scholar
  • 12 Scully M, Hunt BJ, Benjamin S. et al. Guidelines on the diagnosis and management of thrombotic thrombocytopenic purpura and other thrombotic microangiopathies. British J Haematol 2012; 158: 323-335 doi:10.1111/j.1365-2141.2012.09167.x
    CrossrefPubMedGoogle Scholar
  • 13 Saliba F, Ichaï P, Azoulay D. et al. Successful long-term outcome of ABO-incompatible liver transplantation using antigen-specific immunoadsorption columns. Ther Apher Dial 2010; 14: 116-123 doi:10.1111/j.1744-9987.2009.00792.x
    CrossrefPubMedGoogle Scholar
  • 14 Thölking G, Koch R, Pavenstädt H. et al. Antigen-Specific versus Non-Antigen-Specific Immunoadsorption in ABO-Incompatible Renal Transplantation. PLoS One 2015; 10: e0131465 doi:10.1371/journal.pone.0131465
    CrossrefPubMedGoogle Scholar
  • 15 Becker LE, Siebert D, Süsal C. et al. Outcomes Following ABO-Incompatible Kidney Transplantation Performed After Desensitization by Nonantigen-Specific Immunoadsorption. Transplantation 2015; 99: 2364-2371 doi:10.1097/TP.0000000000000753
    CrossrefPubMedGoogle Scholar
  • 16 Ahmed T, Senzel L. The role of therapeutic apheresis in the treatment of acute antibody-mediated kidney rejection. J Clin Apher 2012; 27: 173-177 doi:10.1002/jca.21211
    CrossrefPubMedGoogle Scholar
  • 17 Böhmig GA, Wahrmann M, Regele H. et al. Immunoadsorption in severe C4d-positive acute kidney allograft rejection: a randomized controlled trial. Am J Transplant 2007; 7: 117-121 doi:10.1111/j.1600-6143.2006.01613.x
    CrossrefPubMedGoogle Scholar
  • 18 Becker LE, Süsal C, Morath C. Kidney transplantation across HLA and ABO antibody barriers. Curr Opin Organ Transplant 2013; 18: 445-454 doi:10.1097/MOT.0b013e3283636c20
    PubMedGoogle Scholar
  • 19 Jayne DRW, Gaskin G, Rasmussen N. et al. European Vasculitis Study Group. Randomized Trial of Plasma Exchange or High-Dosage Methylprednisolone as Adjunctive Therapy for Severe Renal Vasculitis. J Am Soc Nephrol 2007; 18: 2180-2188 doi:10.1681/ASN.2007010090
    CrossrefPubMedGoogle Scholar
  • 20 De Lind Van Wijngaarden RA, Hauer HA, Wolterbeek R. et al. EUVAS. Chances of Renal Recovery for Dialysis-Dependent ANCA-Associated Glomerulonephritis. J Am Soc Nephrol 2007; 18: 2189-2197 doi:10.1681/ASN.2007010066
    CrossrefPubMedGoogle Scholar
  • 21 Palmer A, Cairns T, Dische F. et al. Treatment of rapidly progressive glomerulonephritis by extracorporeal immunoadsorption, prednisolone and cyclophosphamide. Nephrol Dial Transplant 1991; 6: 536-542 doi:10.1093/ndt/6.8.536
    CrossrefPubMedGoogle Scholar
  • 22 Stegmayr BG, Almroth G, Berlin G. et al. Plasma exchange or immunoadsorption in patients with rapidly progressive crescentic glomerulonephritis. A Swedish multi-center study. Int J Artif Organs 1999; 22: 81-87
    CrossrefPubMedGoogle Scholar
  • 23 Matic G, Michelsen A, Hofmann D. et al. Three cases of C-ANCA-positive vasculitis treated with immunoadsorption: possible benefit in early treatment. Ther Apher 2001; 5: 68-72
    CrossrefPubMedGoogle Scholar
  • 24 Fencl F, Simková E, Vondrák K. et al. Recurrence of nephrotic proteinuria in children with focal segmental glomerulosclerosis after renal transplantation treated with plasmapheresis and immunoadsorption: case reports. Transplantation Proc 2007; 39: 3488-3490 doi:10.1016/j.transproceed.2007.09.045
    CrossrefPubMedGoogle Scholar
  • 25 Morath C, Wei C, Macher-Goeppinger S. et al. Management of severe recurrent focal segmental glomerulosclerosis through circulating soluble urokinase receptor modification. Am J Ther 2013; 20: 226-229 doi:10.1097/MJT.0b013e3182811aca
    CrossrefPubMedGoogle Scholar
  • 26 Lionaki S, Vlachopanos G, Georgalis A. et al. Individualized scheme of immunoadsorption for the recurrence of idiopathic focal segmental glomerulosclerosis in the graft: a single center experience. Ren Fail 2015; 37: 777-783 doi:10.3109/0886022X.2015.1015366
    CrossrefPubMedGoogle Scholar
  • 27 Beaudreuil S, Zhang X, Kriaa F. et al. Protein A immunoadsorption cannot significantly remove the soluble receptor of urokinase from sera of patients with recurrent focal segmental glomerulosclerosis. Nephrol Dial Transplant 2014; 29: 458-463 doi:10.1093/ndt/gft453
    CrossrefPubMedGoogle Scholar
  • 28 Köhler W, Bucka C, Klingel R. A randomized and controlled study comparing immunoadsorption and plasma exchange in myasthenic crisis. J Clin Apher 2011; 26: 347-355 doi:10.1002/jca.20317
    CrossrefPubMedGoogle Scholar
  • 29 Galldiks N, Dohmen C, Neveling M. et al. Selective immune adsorption treatment of severe Guillain Barre syndrome in the intensive care unit. Neurocrit Care 2009; 11: 317-321 doi:10.1007/s12028-009-9252-6
    CrossrefPubMedGoogle Scholar
  • 30 Seta T, Nagayama H, Katsura K. et al. Factors influencing outcome in Guillain-Barre Syndrome: comparison of plasma adsorption against other treatments. Clin Neurol Neurosurg 2005; 107: 491-496 doi:10.1016/j.clineuro.2004.12.019
    CrossrefPubMedGoogle Scholar
  • 31 Bramlage CP, Schröder K, Bramlage P. et al. Predictors of complications in therapeutic plasma exchange. J Clin Apher 2009; 24: 225-231 doi:10.1002/jca.20217
    CrossrefPubMedGoogle Scholar
  • 32 Belàk M, Borberg H, Jimenez C, Oette K. Technical and clinical experience with protein A immunoadsorption columns. Transfus Sci 1994; 15: 419-422 doi:10.1016/0955-3886(94)90174-0
    CrossrefPubMedGoogle Scholar
  • 33 Yeh JH, Chiu HC. Comparison between double-filtration plasmapheresis and immunoadsorption plasmapheresis in the treatment of patients with myasthenia gravis. J Neurol 2000; 247: 510-513 doi:10.1007/s004150070149
    CrossrefPubMedGoogle Scholar
  • 34 Koziolek MJ, Tampe D, Bähr M. et al. Immunoadsorption therapy in patients with multiple sclerosis with steroid-refractory optical neuritis. J Neuroinflammation 2012; 9: 80 doi:10.1186/1742-2094-9-80
    PubMedGoogle Scholar
  • 35 Garg RK. Acute disseminated encephalomyelitis. Postgrad Med J 2003; 79: 11-17 doi:10.1136/pmj.79.927.11
    CrossrefPubMedGoogle Scholar
  • 36 Kaynar L, Altuntas F, Aydogdu I. et al. Therapeutic plasma exchange in patients with neurologic diseases: retrospective multicenter study. Transfus Apher Sci 2008; 38: 109-115 doi:10.1016/j.transci.2007.11.002
    CrossrefPubMedGoogle Scholar
  • 37 Keegan M, Pineda AA, McClelland L. et al. Plasma exchange for severe attacks of CNS demyelination: Predictors of response.,. 2002; 58: 143-146 doi:10.1212/wnl.58.1.143
    PubMedGoogle Scholar
  • 38 Noseworthy JH, Lucchinetti C, Rodriguez M, Weinshenker BG. Multiple sclerosis. N Engl J Med 2000; 343: 938-952 doi:10.1056/NEJM200009283431307
    CrossrefPubMedGoogle Scholar
  • 39 Szczepiorkowski ZM, Winters JL, Bandarenko N. et al. Apheresis Applications Committee of the American Society for Apheresis. Guidelines on the use of therapeutic apheresis in clinical practice--evidence-based approach from the Apheresis Applications Committee of the American Society for Apheresis. J Clin Apher 2010; 25: 83-177 doi:10.1002/jca.20240
    CrossrefPubMedGoogle Scholar
  • 40 Wilson HL. B cells contribute to MS pathogenesis through antibody-dependent and antibody-independent mechanisms. Biologics 2012; 6: 117-123 doi:10.2147/BTT.S24734
    PubMedGoogle Scholar
  • 41 Keegan M, König F, McClelland R. et al. Relation between humoral pathological changes in multiple sclerosis and response to therapeutic plasma exchange. Lancet 2005; 366: 579-582 doi:10.1016/S0140-6736(05)67102-4
    CrossrefPubMedGoogle Scholar
  • 42 Meuth SG, Göbel K, Wiendl H. Immune therapy of multiple sclerosis--future strategies. Curr Pharm Des 2012; 18: 4489-4497 doi:10.2174/138161212802502198
    CrossrefPubMedGoogle Scholar
  • 43 Multiple Sclerosis Therapy Consensus Group (MSTCG). Wiendl H, Toyka KV, Rieckmann P. et al. Basic and escalating immunomodulatory treatments in multiple sclerosis: current therapeutic recommendations. J Neurol 2008; 255: 1449-1463 doi:10.1007/s00415-008-0061-1
    CrossrefPubMedGoogle Scholar
  • 44 Reindl M, Linington C, Brehm U. et al. Antibodies against the myelin oligodendrocyte glycoprotein and the myelin basic protein in multiple sclerosis and other neurological diseases: a comparative study. Brain 1999; 122: 2047-2056 doi:10.1093/brain/122.11.2047
    CrossrefPubMedGoogle Scholar
  • 45 Berger T. Is there a rationale for therapeutic immunoadsorption in multiple sclerosis?. Eur J Clin Invest 2005; 35: 467-468 doi:10.1111/j.1365-2362.2005.01546.x
    CrossrefPubMedGoogle Scholar
  • 46 Kuerten S, Pauly R, Blaschke S. et al. [The significance of a B cell-dependent immunopathology in multiple sclerosis]. Fortschr Neurol Psychiatr 2011; 79: 83-91 doi:10.1055/s-0029-1245937
    Article in Thieme ConnectPubMedGoogle Scholar
  • 47 Klingel R, Heibges A, Fassbender C. Plasma exchange and immunoadsorption for autoimmune neurologic diseases – current guidelines and future perspectives. Atheroscler Suppl 2009; 10: 129-132 doi:10.1016/S1567-5688(09)71827-6
    CrossrefPubMedGoogle Scholar
  • 48 Weiner HL, Dau PC, Khatri BO. et al. Double-blind study of true vs. sham plasma exchange in patients treated with immunosuppression for acute attacks of multiple sclerosis. Neurology 1989; 39: 1143-1149 doi:10.1212/wnl.39.9.1143
    CrossrefPubMedGoogle Scholar
  • 49 Weinshenker BG, O’Brien PC, Petterson TM. et al. A randomized trial of plasma exchange in acute central nervous system inflammatory demyelinating disease. Ann Neurol 1999; 46: 878-886
    CrossrefPubMedGoogle Scholar
  • 50 Magaña SM 1, Keegan BM, Weinshenker BG. et al. Beneficial plasma exchange response in central nervous system inflammatory demyelination. Arch Neurol 2011; 68: 870-878 doi:10.1001/archneurol.2011.34
    CrossrefPubMedGoogle Scholar
  • 51 Trebst C, Bronzlik P, Kielstein JT. et al. Immunoadsorption therapy for steroid-unresponsive relapses in patients with multiple sclerosis. Blood Purif 2012; 33: 1-6 doi:10.1159/000332397
    CrossrefPubMedGoogle Scholar
  • 52 Linker RA, Chan A, Sommer M. et al. Plasma exchange therapy for steroid-refractory superimposed relapses in secondary progressive multiple sclerosis. J Neurol 2007; 254: 1288-1289 doi:10.1007/s00415-006-0497-0
    CrossrefPubMedGoogle Scholar
  • 53 Gold R. Diagnose und Therapie der Multiplen Sklerose. Diener HC. P. N, Hrsg Leitlinien für Diagnostik und Therapie in der Neurologie. 5. Aufl. 2012 letztes Online-Update: 2014
    PubMedGoogle Scholar
  • 54 Schröder A, Fischer M, Meyer C. et al. Therapeutic plasma exchange for steroid unresponsive multiple sclerosis relapss – a long-term follow-up observation including 35 patients. Akt Neurol 2009; 36: 105-110 doi:10.1055/s-0028-1090231
    Article in Thieme ConnectGoogle Scholar
  • 55 Trebst C, Reising A, Kielstein JT. et al. Plasma exchange therapy in steroid-unresponsive relapses in patients with multiple sclerosis. Blood Purif 2009; 28: 108-115 doi:10.1159/000224630
    CrossrefPubMedGoogle Scholar
  • 56 de Andrés C, Anaya F, Giménez-Roldan S. [Plasma immunoadsorption treatment of malignant multiple sclerosis with severe and prolonged relapses]. Rev Neurol 2000; 30: 601-605
    PubMedGoogle Scholar
  • 57 Mauch E. et al. [Immunoadsorption for steroid-unresponsive multiple sclerosis-relapses: clinical data of 14 patients]. Nervenarzt 2011; 82: 1590-1595 doi:10.1007/s00115-011-3324-5
    CrossrefPubMedGoogle Scholar
  • 58 Jarius S, Ruprecht K, Wildemann B. et al. Contrasting disease patterns in seropositive and seronegative neuromyelitis optica: A multicentre study of 175 patients. J Neuroinflammation 2012; 9: 14 doi:10.1186/1742-2094-9-14
    CrossrefPubMedGoogle Scholar
  • 59 Trebst C, Berthele A, Jarius S. et al. [Diagnosis and treatment of neuromyelitis optica. Consensus recommendations of the Neuromyelitis Optica Study Group]. Nervenarzt 2011; 82: 768-777 doi:10.1007/s00115-010-3192-4
    CrossrefPubMedGoogle Scholar
  • 60 Jarius S, Wildemann B, Paul F. Neuromyelitis optica: clinical features, immunopathogenesis and treatment. Clin Exp Immunol 2014; 176: 149-164 doi:10.1111/cei.12271
    CrossrefPubMedGoogle Scholar
  • 61 Cortese I, Chaudhry V, So YT. et al. Evidence-based guideline update: Plasmapheresis in neurologic disorders: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2011; 76: 294-300 doi:10.1212/WNL.0b013e318207b1f6
    CrossrefPubMedGoogle Scholar
  • 62 Cortese I, Cornblath DR. Therapeutic plasma exchange in neurology: 2012. J Clin Apher 2013; 28: 16-19 doi:10.1002/jca.21266
    CrossrefPubMedGoogle Scholar
  • 63 Hoffmann F, Kraft A, Heigl F. et al. [Tryptophan immunoadsorption for multiple sclerosis and neuromyelitis optica: therapy option for acute relapses during pregnancy and breastfeeding]. Nervenarzt 2015; 86: 179-186 doi:10.1007/s00115-014-4239-8
    CrossrefPubMedGoogle Scholar
  • 64 Vincent A, Buckley C, Schott JM. et al. Potassium channel antibody-associated encephalopathy: a potentially immunotherapy-responsive form of limbic encephalitis. Brain 2004; 127: 701-712 doi:10.1093/brain/awh077
    CrossrefPubMedGoogle Scholar
  • 65 Graus F, Saiz A, Lai M. et al. Neuronal surface antigen antibodies in limbic encephalitis: clinical-immunologic associations. Neurology 2008; 71: 930-936 doi:10.1212/01.wnl.0000325917.48466.55
    CrossrefPubMedGoogle Scholar
  • 66 Anderson NE, Barber PA. Limbic encephalitis – a review. J Clin Neurosci 2008; 15: 961-971 doi:10.1016/j.jocn.2007.12.003
    CrossrefPubMedGoogle Scholar
  • 67 Friese MA, Magnus T. [Autoimmune synaptic encephalopathies]. Nervenarzt 2011; 82: 1239-1249 doi:10.1007/s00115-010-3219-x
    CrossrefPubMedGoogle Scholar
  • 68 Ehrlich S, Fassbender CM, Blaes C. et al. [Therapeutic apheresis for autoimmune encephalitis: a nationwide data collection]. Nervenarzt 2013; 84: 498-507 doi:10.1007/s00115-012-3710-7
    CrossrefPubMedGoogle Scholar
  • 69 Marn Pernat A, Buturovic-Ponikvar J, Svigelj V, Ponikvar R. Guillain-Barré syndrome treated by membrane plasma exchange and/or immunoadsorption. Ther Apher Dial 2009; 13: 310-313 doi:10.1111/j.1744-9987.2009.00730.x
    CrossrefPubMedGoogle Scholar
  • 70 Chevret S, Hughes RA, Annane D. Plasma exchange for Guillain-Barré syndrome. Cochrane Database Syst Rev 2017; 2: CD001798 doi:10.1002/14651858.CD001798.pub3
    CrossrefPubMedGoogle Scholar
  • 71 Meriggioli MN, Sanders DB. Autoimmune myasthenia gravis: emerging clinical and biological heterogeneity. Lancet Neurol 2009; 8: 475-490 doi:10.1016/S1474-4422(09)70063-8
    CrossrefPubMedGoogle Scholar
  • 72 Antozzi C, Gemma M, Regi B. et al. A short plasma exchange protocol is effective in severe myasthenia gravis. J Neurol 1991; 238: 103-107 doi:10.1007/bf00315690
    CrossrefPubMedGoogle Scholar
  • 73 Guptill JT, Sanders DB, Evoli A. Anti-MuSK antibody myasthenia gravis: clinical findings and response to treatment in two large cohorts. Muscle Nerve 2011; 44: 36-40 doi:10.1002/mus.22006
    CrossrefPubMedGoogle Scholar
  • 74 Antozzi C, Berta E, Confalonieri P. et al. Protein-A immunoadsorption in immunosuppression-resistant myasthenia gravis. Lancet 1994; 343: 124
    CrossrefPubMedGoogle Scholar
  • 75 Grob D, Simpson D, Mitsumoto H. et al. Treatment of myasthenia gravis by immunoadsorption of plasma. Neurology 1995; 45: 338-344 doi:10.1212/wnl.45.2.338
    CrossrefPubMedGoogle Scholar
  • 76 Leite MI, Jacob S, Viegas S. et al. IgG1 antibodies to acetylcholine receptors in ‘seronegative’ myasthenia gravis. Brain 2008; 131: 1940-1952 doi:10.1093/brain/awn092
    CrossrefPubMedGoogle Scholar