Ann Lab Med.  2012 Jul;32(4):283-288. 10.3343/alm.2012.32.4.283.

Role of Plasma Exchange in ABO-incompatible Kidney Transplantation

Affiliations
  • 1Department of Laboratory Medicine, Yonsei University Health System, Seoul, Korea. hyunok1019@yuhs.ac
  • 2Department of Surgery, Yonsei University Health System, Seoul, Korea.

Abstract

BACKGROUND
In the past, ABO incompatibility was an absolute contraindication for solid organ transplantation. However, multiple recent trials have suggested strategies for overcoming the reactions between graft antigens and recipient antibodies that cause graft rejection. In this study, we determined the usefulness of plasma exchange (PE) for removing anti-A/B antibodies that cause hyperacute/acute humoral graft rejection in patients undergoing ABO-incompatible kidney transplantation.
METHODS
In our study, 12 patients underwent ABO-incompatible kidney transplantation. All recipients received pre-transplantation conditioning by PE or intravenous immunoglobulin (IVIG) administration. After pre-transplantation conditioning, anti-A/B antibody titers were evaluated, and transplantation was performed when the titer was below 1:8. To assess the transplantation outcome, anti-A/B antibody titers, creatinine level, estimated glomerular filtration rate (eGFR), and proteinuria levels were measured.
RESULTS
Anti-A/B antibody titers were below 1:8 in all patients at the time of transplantation. eGFR measured on post-transplant day 14 showed that 10 patients had immediate recovery of graft function, while 2 patients had slow recovery of graft function. Short-term outcomes of ABO-incompatible kidney transplantation (measured as creatinine levels) after reducing anti-A/B antibody titers were similar to those of ABO-compatible kidney transplantation. After transplantation, the anti-A/B antibody titers were below 1:8 in 7 patients, but the remaining 5 patients required post-transplantation PE and IVIG treatment to prevent antigen-antibody reactions.
CONCLUSIONS
With the increasing demand for kidney donations, interest in overcoming the ABO incompatibility barrier has increased. PE may be an important breakthrough in increasing the availability of kidneys for transplantation.

Keyword

Plasma exchange; ABO blood-group system; Blood group incompatibility; Kidney transplantation

MeSH Terms

ABO Blood-Group System/*immunology
Adult
*Blood Group Incompatibility/immunology
Creatinine/blood
Female
Glomerular Filtration Rate
Graft Rejection/therapy
Humans
Immunoglobulins, Intravenous/therapeutic use
Isoantibodies/immunology/physiology
Kidney Transplantation/*immunology
Male
Middle Aged
*Plasma Exchange
Proteinuria
Transplantation Conditioning
Transplantation Immunology

Figure

  • Fig. 1 Desentization protocol for ABO-incompatible living donor kidney transplantation at Yonsei University Health System. Abbreviations: PE, plasma exchange; IVIG, intravenous immunoglobulin; KT, kidney transplantation.


Cited by  2 articles

The Effect of Bortezomib on Antibody-Mediated Rejection after Kidney Transplantation
Juhan Lee, Beom Seok Kim, Yongjung Park, Jae Geun Lee, Beom Jin Lim, Hyeon Joo Jeong, Yu Seun Kim, Kyu Ha Huh
Yonsei Med J. 2015;56(6):1638-1642.    doi: 10.3349/ymj.2015.56.6.1638.

Therapeutic Plasma Exchange Using the Spectra Optia Cell Separator Compared With the COBE Spectra
Do-kyun Kim, Sinyoung Kim, Seok Hoon Jeong, Hyun Ok Kim, Hyung Jik Kim
Ann Lab Med. 2015;35(5):506-509.    doi: 10.3343/alm.2015.35.5.506.


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