Plasmapheresis in the treatment of acute vascular rejection: an experience on a dialysis unit

Despite numerous the advances made in transplantation, acute rejection remains a major complication. Recent studies have shown that the use of plasmapheresis in the treatment of acute vascular rejection improves the chances of graft survival. In 1997 the plasmapheresis was transferred to the management of the renal unit, because we could offer a 24-hour service for all acute cases in our hospital. The number of cases has steadily increased, incorporating not only plasmapheresis, but also stemcellpheresis and red blood cell exchanges. Since July 2003, we have started using plasmapheresis in the treatment of acute vascular rejection in renal transplants. When a biopsy shows acute vascular rejection (A.V.R), combined with a decreased urine production, the patient commences therapy. Treatment consists of consecutive sessions, alternating between two sessions using saline/ albumin followed by one session using fresh frozen plasma. Depending on the lymphocyte count, therapy is carried out in conjunction with a course of Antithymocyte globulin (A.T.G.) between July 2003 and October 2004, 124 transplants were carried out, 15 suffered from acute rejection. Six were diagnosed with A.V.R, of these six; five were successfully treated with plasmapheresis and A.T.G. One patient only needed plasmapheresis to ensure a reversal of acute vascular rejection. We encountered no problem with the technique itself and although plasmapheresis seems to improve the outcome of graft survival, we need to ask ourselves, as demand increases: "Do we have the capacity to treat these patients on our unit in the future and is it our domain?"