DESCRIBING THE EFFECTIVENESS OF IMMUNOSUPPRESSION DRUGS AND APHERESIS IN THE TREATMENT OF TRANSPLANT PATIENTS

HATTERSLEY JG, CHAPPELL MJ, ZEHNDER D, HIGGINS RM, EVANS ND.

HENRY ADELEYE, MARCI SEARLES

DAVID SAVAGE 2006

1990

Heart transplant 1990

Terminally-ill journalist Adrian Sudbury is campaigning to educate young adults about what it means to be a bone marrow donor

PURPOSE OF OUR CHOICE IN CHOOSING THIS PAPER

• Henry is interested in working with orthopedics, which includes limb reattachment.

• Marci wanted to understand why educated adults are not more interested in being organ donors.

FACTORS DETERMINING ORGAN COMPATIBILITY

Blood type Genetic markers What kind of organ/tissue Immunoglobulins IgG,IgM,IgA Age and sex of the giver and receiver of

certain organs.

Immunosuppressant drugs can change everything!

IMMUNITY

IgG: 2 identical Y chains can pass through human placenta Is a secondary immune response

IMMUNITY

IgA: H chain, J chain, L chain, secretory

component Mucosal immunity

IMMUNITY

IMMUNOSUPPRESSANT DRUGS

5 classes of immunosuppressant drugs 1)glucocorticoids 2)cytostatics 3)antibodies 4)drugs acting on immunophilins5)other drugs.

IMMUNOSUPPRESSANT DRUGS

Used to prevent rejection of transplanted organs

Auto immune disease

Chronic anti-inflammatory

APHERESIS

Apheresis: the process by which plasma or cellular components are separated from the whole blood

PLASMAPHERESIS DFPP

Plasmapheresis DFPP: apheresis used to remove blood plasma.

In DFPP, plasma is separated with a plasma separator and passesthrough the plasma component separator with a small pore size.

Large molecular-weight proteins are discarded andsmall molecular-weight substances includingvaluable albumin are returned to the patient.

Small amount of substitution fluid such as albumin may be added.

PLASMAPHERESIS DFPP

PLASMA EXCHANGE (PE)

Plasma exchange: Plasma exchange involves replacing the plasma (the liquid part of a person’s blood) with plasma from a donor.

PLASMA ABSORPTION

In PA, plasma is separated with a plasma separator and flows into a plasma adsorption column.

Pathogenic substances are adsorbed and removed due to affinity between ligands

and pathogenic substances.

Note: Fluids are not replaced

PLASMA ABSORPTION

RESULTS

Patient 1 After three

successive apheresis treatments

Vertical line after transplant occurs

Antibody production suppressed

CONT.

Patient 3 Received extended

apheresis treatment

IgM shows typical response

IgG and IgA show increased immune response

CONT.

CONT.

PA more consistent with each antibody type IgM moves consistently with each apheresis

method IgG and IgA differ amongst apheresis types PE clears IgG fastest, PA clears it slowest DFPP clears IgA fastest, PA clears it slowest Can customize apheresis method depending on

patient’s condition

CONCLUSION

Examines the effectiveness of certain immunosuppressive procedures

Enables clinicians to better categorize the patient’s response to implants

Enables clinicians to estimate antibody production during transplant procedures using algorithm

SHORTCOMINGS?

No data post-operatively for the patient in figure 3.

Plasmapheresis used in unequal proportion compared to the two other methods of apheresis.

Limited sample size Quantity and type of

immunosuppressive drugs used was not recorded

QUESTIONS?