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Double-filtration plasmapheresis.

Kazunari Tanabe¹

¹Department of Urology, Graduate School of Medicine, Tokyo Women's Medical University, Tokyo, Japan. tanabe@kc.ac.jp

Transplantation

|January 25, 2008

Summary

Double-filtration plasmapheresis (DFPP) effectively removes harmful anti-ABO antibodies, enabling successful ABO-incompatible kidney transplants. This method significantly reduces the need for replacement fluids, improving patient outcomes in transplantation.

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Area of Science:

Nephrology
Immunology
Transplantation

Background:

Hyperacute rejection in ABO-incompatible kidney transplants is caused by recipient anti-ABO antibodies.
Temporary elimination of these antibodies is crucial for successful transplantation.
Plasmapheresis and immunoadsorption are common methods for antibody removal.

Purpose of the Study:

To evaluate the efficacy and safety of double-filtration plasmapheresis (DFPP) for reducing anti-ABO antibody titers in recipients undergoing ABO-incompatible kidney transplantation.
To assess the success rate of a pretransplant conditioning regimen incorporating DFPP and immunosuppressive drugs.

Main Methods:

Utilized double-filtration plasmapheresis (DFPP) for selective immunoglobulin removal, requiring minimal substitution fluid.
Administered immunosuppressive drugs (tacrolimus, mycophenolate mofetil, methylprednisolone) 7 days pre-transplant.
Performed 3-4 DFPP sessions until anti-ABO antibody titers were ≤1:32, with rituximab and basiliximab administered peri-transplant.

Main Results:

The pretransplant conditioning regimen achieved a 97% desensitization success rate in 39 patients between 2005-2006.
Only one patient failed transplantation due to inability to reach the target antibody titer (< or =1:32).
DFPP effectively and safely reduced anti-ABO antibody levels.

Conclusions:

Double-filtration plasmapheresis is an effective and safe method for eliminating anti-ABO antibodies in ABO-incompatible kidney transplant recipients.
The described pretransplant conditioning protocol significantly contributes to successful ABO-incompatible living-related kidney transplantation (ABO-ILKT).
DFPP offers an advantage by minimizing the required volume of replacement fluids compared to conventional methods.