Coupled plasma filtration adsorption in the treatment of severe sepsis in patients after kidney transplantation

A.V. Vatazin, A.B. Zul'karnaev, M. Krstich, R.O. Kantarija

SBIH MR “Moscow's regional research clinical institute n.a. M.F. Vladimirskiy”, the Surgical Department of Transplantology and Dialysis
Post-transplant septic complications remain a major problem in organ transplantation. Treatment of sepsis in renal transplant recipients is a particularly challenging task due to the long-term use of immunosuppressive medications. According to modern concepts, the key role in the sepsis progression plays an uncontrolled systemic inflammatory response.
One of the promising treatment modalities able to suppress the systemic inflammatory response is a coupled plasma filtration adsorption (CPFA). However, there have been no studies examining the effectiveness of this technique for the sepsis in the kidney transplant patients, which emphasie the relevance of this study. We conducted a comparative assessment of the effects of hemofiltration (HF) and CPFA on the changes in the mean arterial pressure and the PaO2/FiO2 coefficient in septic patients after kidney transplantation. The study group patients were treated with CPFA in combination with HF while the patients of the comparison group received only HF. The combination of CPFA and HF was found to increase the mean arterial pressure and the PaO2/FiO2 coefficient, as well as to reduce the need for sympathomimetic agent administration.
In conclusion, additional sorption removal of circulating inflammatory mediators reduces the activity of the systemic inflammatory response, thus significantly improving the effectiveness of the therapy.


  1. Бикбов Б.Т. Томилина Н.А. Состояние заместительной терапии больных хронической почечной недостаточностью в Российской Федерации в 1998–2009 гг. Отчет по данным Российского регистра заместительной почечной терапии // Нефрология и диализ. – 2011. – № 13(3). – С. 150–264.
  2. Сепсис: классификация, клинико-диагностическая концепция и лечение: Практическое руководство / Под ред. Савельева В.С., Гельфанда Б.Р. – 2-е изд., доп. и перераб. – М.: ООО «Медицинское информационное агентство». – 2010. – 352 с.
  3. Cinel I., Dellinger R.P. Advances in pathogenesis and management of sepsis // Curr. Opin. Infect. Dis. – 2007. Vol. 20(4). – P. 345–352.
  4. Azevedo L.C., Park M., Schettino G.P. Novel potential therapies for septic shock // Shock. – 2008. – Vol. 30(1). – P .60–66.
  5. Peng Z., Singbartl K., Simon P. Blood purification in sepsis: a new paradigm. Contrib // Nephrol. – 2010. – Vol. 165. – P. 322–328.
  6. Peng Z., Pai P., Han-Min W. Evaluation of the effects of pulse high-volume hemofiltration in patients with severe sepsis: a preliminary study // Int. J. Artif. Organs. – 2010. – Vol. 33(8). – P. 505–511.
  7. Schefold J.C., Hasper D., Jörres A. Organ crosstalk in critically ill patients: hemofiltration and immunomodulation in sepsis // Blood Purif. – 2009. – Vol. 28(2). – P. 116–123.
  8. Payen D., Mateo J., Cavaillon J.M. Impact of continuous venovenous hemofiltration on organ failure during the early phase of severe sepsis: a randomized controlled trial // Crit. Care Med. – 2009. – Vol. 37(3). – P. 803–810.
  9. Ratanarat R., Brendolan A., Piccinni P. Pulse high-volume haemofiltration for treatment of severe sepsis: effects on hemodynamics and survival // Crit. Care. – 2005. – Vol. 9(4). – P. 294–302.
  10. Bouman C.S., Oudemans-van Straaten H.M., Schultz M.J., Vroom M.B. Hemofiltration in sepsis and systemic inflammatory response syndrome: the role of dosing and timing // J. Crit. Care. – 2007. – Vol. 22(1). – P. 1–12.
  11. Honoré P.M., Joannes-Boyau O., Gressens B. Blood and plasma treatments: high-volume hemofiltration -a global view // Contrib. Nephrol. – 2007. – Vol. 156. – P. 371–386.
  12. Honore P.M., Joannes-Boyau O., Boer W., Collin V. High-volume hemofiltration in sepsis and SIRS: current concepts and future prospects // Blood Purif. – 2009. – Vol. 28(1). – P. 1–11.
  13. Honoré P.M., Joannes-Boyau O., Collin V. Continuous hemofiltration in 2009: what is new for clinicians regarding pathophysiology, preferred technique and recommended dose? // Blood Purif. – 2009. – Vol. 28(2). – P. 135–143.
  14. Ronco C., Brendolan A., d'Intini V. Coupled plasma filtration adsorption: rationale, technical development and early clinical experience // Blood Purif. – 2003. – Vol. 21(6). – P. 409–416.
  15. Formica M., Inguaggiato P., Bainotti S., Wratten M.L. Coupled plasma filtration adsorption // Contrib. Nephrol. – 2007. – Vol. 156. – P. 405–410.
  16. Bellomo R., Tetta C., Brendolan A., Ronco C. Coupled plasma filtration adsorption // Blood Purif. – 2002. – Vol. 20(3). – P. 289–292.
  17. Bellomo R., Tetta C., Ronco C. Coupled plasma filtration adsorption // Intensive Care Med. – 2003. – Vol. 29(8). – P. 1222–1228.
  18. Taniguchi T. Cytokine adsorbing columns // Contrib. Nephrol. – 2010. – Vol. 166. – P. 134–141.
  19. Stengl M., Sykora R., Chvojka J. Differential effects of hemofiltration and of coupled plasma filtration adsorption on cardiac repolarization in pigs with hyperdynamic septic shoc // Shock. – 2010. – Vol. 33(1). – P. 101–105.
  20. Sykora R., Chvojka J., Krouzecky A. High versus standard-volume haemofiltration in hyperdynamic porcine peritonitis: effects beyond haemodynamics? // Intensive Care Med. – 2009. – Vol. 35(2). – P. 371–380.
  21. Berlot G., Bianco N., Tomasini A. Changes in microvascular blood flow during coupled plasma filtration and adsorption // Anaesth. Intensive Care. – 2011. – Vol. 39(4). – P. 687–689.
  22. Nakamura M., Oda S., Sadahiro T. Treatment of severe sepsis and septic shock by CHDF using a PMMA membrane hemofilter as a cytokine modulator // Contrib. Nephrol. – 2010. – Vol. 166. – P. 73–82.
  23. Sakamoto Y., Mashiko K., Obata T. Effectiveness of continuous hemodiafiltration using a polymethylmethacrylate membrane hemofilter after polymyxin B-immobilized fiber column therapy of septic shock // ASAIO J. – 2008. – Vol. 54(1). – P. 129–132.
  24. DiLeo M.V., Kellum J.A., Federspiel W.J. A simple mathematical model of cytokine capture using a hemoadsorption device // Ann. Biomed. Eng. – 2009. – Vol. 37(1). – P. 222–229.

About the Autors

Author Information:
A.V. Vatazin – Ph.D., Prof., Head of the Department of Transplantology, Nephrology and Surgical Hemocorrection, Head of the Department of Transplantology, Nephrology and Artificial Organs of FAME of SBIH MR “MRRCI”, the Honored Scientist of Russia
A.B. Zul'karnaev – Ph.D., Associate Professor of the Department of Transplantology, Nephrology and Artificial Organs; e-mail:
M. Krstich – Ph.D., Research Scientist of the Surgical Department of Organ Donation
R.O. Kantarija – Ph.D., Nephrologist of the Surgical Department of Transplantology and Dialysis

Similar Articles

Бионика Медиа