scholarly journals Therapeutic plasma exchange for kidney transplantation: the problem of antibody-mediated rejection

Transfusion ◽  
2015 ◽  
Vol 55 (4) ◽  
pp. 696-699
Author(s):  
Karen E. King ◽  
Robert A. Montgomery
Keyword(s):  
Kidney Transplantation ◽  
Plasma Exchange ◽  
Therapeutic Plasma Exchange ◽  
Antibody Mediated Rejection

scholarly journals Safety and Efficacy of Tandem Hemodialysis and Selective Plasma Exchange in Pretransplant Desensitization of ABO-Incompatible Kidney Transplantation

2021 ◽  
pp. 1-8
Author(s):  
Ako Hanaoka ◽  
Toshihide Naganuma ◽  
Daijiro Kabata ◽  
Daichi Morii ◽  
Yoshiaki Takemoto ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Plasma Exchange ◽  
Treatment Time ◽  
Venous Pressure ◽  
Transmembrane Pressure ◽  
Safety And Efficacy ◽  
Antibody Mediated Rejection ◽  
Tandem Therapy ◽  
Internal Pressures ◽  
Over Time

<b><i>Introduction:</i></b> In patients requiring both hemodialysis (HD) and apheresis, the 2 treatments can be performed simultaneously. At our hospital, selective plasma exchange (SePE) is often performed along with HD for removal of isoagglutinins before ABO-incompatible (ABOi) kidney transplantation. The 2 treatments can be completed within the HD schedule, which allows the treatment time to be shortened. This approach is also less stressful for patients because fewer punctures are required. In this study, we investigated the safety and efficacy of tandem HD and SePE. <b><i>Methods:</i></b> A total of 58 SePE sessions in 30 ABOi kidney transplant recipients were investigated. The SePE circuit was connected in parallel with the HD circuit, and tandem HD and SePE therapy was performed using filtration methods. The SePE sessions were divided into 2 groups: those with SePE monotherapy (group S, <i>n</i> = 20) and those with tandem therapy (group T, <i>n</i> = 38). Changes in transmembrane pressure (TMP), arterial pressure (AP), venous pressure (VP), and decrease in isoagglutinin titers over time were compared between the groups with adjustment for background data. <b><i>Results:</i></b> The internal pressures (AP and VP) were higher in group T, and there were significant differences in changes of TMP and AP over time between groups T and S. Membrane exchange was required in 1 case in group T due to coagulation. There was a more significant decrease of immunoglobulin G isoagglutinin titers in group T compared to group S. No case had antibody-mediated rejection after transplantation. <b><i>Discussion/Conclusion:</i></b> In HD/SePE tandem therapy, internal pressures were higher and TMP and AP tended to increase more compared to SePE monotherapy, but we were able to perform the 2 treatments without any functional problems. Tandem therapy was also effective in decreasing isoagglutinin titers, which suggests that this may be a beneficial treatment modality as apheresis before ABOi kidney transplantation.

Therapeutic plasma exchange rapidly improves cardiac allograft function in patients with presumed antibody-mediated rejection

2014 ◽  
Vol 29 (6) ◽  
pp. 316-321 ◽  
Author(s):  
Nirupama Singh ◽  
Sean Vanlandingham ◽  
Catlin Halverson ◽  
Marisa B. Marques ◽  
Jose Tallaj ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Cardiac Allograft ◽  
Therapeutic Plasma Exchange ◽  
Antibody Mediated Rejection ◽  
Allograft Function

scholarly journals A clinical case of using therapeutic plasma exchange for the treatment of recurrent focal segmental glomerulosclerosis in a child after kidney transplantation

2021 ◽  
Vol 23 (2) ◽  
pp. 60-66
Author(s):  
I. A. Miloserdov ◽  
V. S. Bogdanov ◽  
P. M. Gadzhieva ◽  
D. A. Saydulaev ◽  
A. A. Kartashev ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Kidney Transplantation ◽  
Plasma Exchange ◽  
Kidney Transplant ◽  
Focal Segmental Glomerulosclerosis ◽  
Graft Function ◽  
Therapeutic Plasma Exchange ◽  
Kidney Graft ◽  
Graft Dysfunction ◽  
Segmental Glomerulosclerosis

Background. Focal segmental glomerulosclerosis (FSGS) of the graft in kidney recipients is a rare and difficultto-diagnose post-kidney transplant complication, which can lead to graft loss and death of the recipient. A unified protocol is required for the treatment of this disease.Materials and methods. A 15-year-old female patient C. diagnosed with stage 5 chronic kidney disease as a result of steroid-resistant nephrotic syndrome with hematuria underwent a living related-donor kidney transplantation. On the third day after the operation, laboratory and imaging data showed kidney graft dysfunction. Patient examinations established the cause of the graft dysfunction – idiopathic nephrotic syndrome in FSGS.Results. For the treatment of recurrent FSGS, the patient had her immunosuppressive therapy converted from tacrolimus to cyclosporin A, and received two 500 mg rituximab injections. Ten sessions of therapeutic plasma exchange (Plasauto Sigma) were performed to remove antibodies to podocytes. During the therapy, diuresis was restored, creatinine and urea levels decreased. Six months after the kidney transplant, graft function was fully restored. Conclusion. The absence of recurrent FSGS within six months during a single course of therapeutic plasma exchange with its subsequent cancellation after restoration of graft function allows to recommend the developed method for the treatment of FSGS in pediatric patients after kidney transplantation.

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