Extracorporeal immunomodulation (EIM) by plasmaleukapheresis (PLP) in the treatment of steroid resistant renal...

We report the use of plasmaleukapheresis (PLP) to treat renal allograft rejection which had failed to respond to conventional pulse corticosteroid therapy. Twenty-three patients who failed to respond to at least 3 boluses of IV methylprednisolone received PLP. Sixteen of these patients had either complete (12) or partial (4) response to PLP. In the responding group, the mean serum creatinine was 1.5 +/- 0.3 mg/dl. In the partially responding group, the mean serum creatinine was 3.9 +/- 0.3 mg/dl. Plasmaleukapheresis resulted in the reduction in levels of circulating immune complexes (CIC), and T and B cells. Circulating null cell levels increased. All 5 patients with low (less than 10%) pretransplant cytotoxic antibody levels had complete response to plasmaleukapheresis. We conclude that PLP, perhaps by removal of CIC, antibody and/or population of circulating T or B cells, may be capable of reversing steroid resistant rejection, especially in patients with low levels of pretransplant cytotoxic antibodies.