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Related Concept Videos

Kidney Transplant II: Surgical Procedure01:26

Kidney Transplant II: Surgical Procedure

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Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...
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Kidney Transplant III: Nursing Management01:16

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Postoperative Nursing Management for Kidney Transplant PatientsPostoperative nursing management care includes monitoring the surgical site, encouraging early movement, and promoting lung health through breathing exercises. Nurses also administer prescribed medications like H2-blockers, such as famotidine, or proton pump inhibitors, like omeprazole, to help prevent gastrointestinal ulcers and bleeding. Fungal infections in the mouth and bladder can result from immunosuppressive and antibiotic...
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A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
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Acute Kidney Injury V: Interprofessional Care01:20

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Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...
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Renal Failure: Dose Adjustments01:11

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In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
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Acute Kidney Injury IV: Diagnostic Studies and Prevention01:30

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Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
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Updated: Sep 9, 2025

Trans-vivo Delayed Type Hypersensitivity Assay for Antigen Specific Regulation
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ABO Antibody Titer Dynamics and Optimization in Incompatible Renal Transplants Using Therapeutic Plasma Exchange.

Anubha Srivastava1, Priti Elhence2, Bharat Singh2

  • 1Transfusion Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND.

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|August 28, 2025
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Summary

High baseline anti-ABO IgG titers in kidney transplant recipients necessitate more pretransplant therapeutic plasma exchange (TPE). However, this does not increase post-transplant TPE, showing TPE protocols are effective for ABO-incompatible kidney transplants.

Keywords:
abo-incompatible kidney transplantantibody-mediated rejectionimmunohematologypatient outcomestherapeutic plasma exchangetransfusion medicine

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Area of Science:

  • Nephrology
  • Immunology
  • Transplantation

Background:

  • ABO-incompatible kidney transplantation (ABOi KT) broadens organ access but requires managing anti-ABO isoagglutinins to prevent antibody-mediated rejection (ABMR).
  • Pre-existing antibody titers significantly influence desensitization protocols and transplant outcomes.

Purpose of the Study:

  • To investigate the correlation between baseline anti-ABO IgG titers (≥64 vs. <64) and the intensity of therapeutic plasma exchange (TPE) needed pre- and post-transplant.
  • To evaluate ABMR incidence, graft function, patient and graft survival, and TPE-related adverse events in a resource-limited setting.

Main Methods:

  • A prospective single-center study involving 20 ABOi KT recipients on a standardized TPE-based desensitization protocol.
  • Patients received tacrolimus-based immunosuppression, TPE, IVIG, rituximab, and ATG, with serial ABO IgG and IgM titer monitoring.
  • Stratification by high (≥64) versus low (<64) baseline IgG titers.

Main Results:

  • Recipients with high baseline IgG titers required significantly more pretransplant TPE sessions (mean 5.2 vs. 3.4; p=0.02).
  • Post-transplant TPE requirements were similar between groups.
  • ABMR occurred in 45% of patients, with a trend towards higher incidence in the high-titer group (not statistically significant).
  • Stable graft function at 24 months, high patient survival, and infrequent, mild TPE-related adverse events were observed.

Conclusions:

  • Elevated baseline IgG titers necessitate intensified pretransplant desensitization but do not mandate increased post-transplant TPE.
  • A standardized, TPE-centered protocol is safe and effective for ABOi KT in resource-limited settings.
  • Risk-adapted strategies and real-time immunomonitoring are crucial for optimizing ABOi KT outcomes.