Clinical analysis of single filtration plasmapheresis using continuous renal replacement therapy machines in kidney transplantation

Abstract

BackgroundPlasmapheresis has become an essential element of kidney transplantation (KT). In the present study, we report clinical outcomes of filtration plasmapheresis using continuous renal replacement therapy machines with a single filter for the first time in Korea.MethodsWe retrospectively analyzed six patients who underwent filtration plasmapheresis for KT in our center; plasmapheresis was performed using the Plasmaflex (Baxter®) with a TPE 2000 filter set (Baxter®) in our hemodialysis unit. Five percent albumin was used as the replacement fluid, and intravenous immunoglobulin G was administered after each plasmapheresis session. The target preoperative ABO isoagglutinin titer was less than 1:8.ResultsFiltration plasmapheresis was performed in four patients for ABO-incompatible KT, one for antibody-mediated rejection after KT, and the last one for positive T cell crossmatch. Altogether, 46 sessions of plasmapheresis were performed. ABO isoagglutinin titers successfully declined to or below the target level in all patients, and all patients successfully received KT with no significant antibody titer rebound. Acute antibody-mediated rejection and positive T cell crossmatch were well treated with filtration plasmapheresis, and no patient required fresh frozen plasma infusion for coagulopathy. There were one episode of hypotension and three of hypocalcemia. No patients experienced bleeding, infection, or allergic reaction.ConclusionFiltration plasmapheresis was effective and safe. Although our result is from a single center, our protocol appears to be promising.

Clinical significance of the abnormal Doppler spectrum of renal blood flow in patients with long-term transplant dysfunction

“…The Doppler spectrum parameters of the renal transplant blood flow in patients with efficient and impaired depuration function (interlobar arteries) in the long-term period following KT Activation of the humoral immunity in the late rejection episodes development more determines its resistance to therapy and poor prognosis regardless of the morphological variant of the latter. Traditionally, acute and chronic humoral rejection are distinguished; however, in essence, these variants of rejection are stages of the same process, that begins with anti-donor antibodies production which form complexes with antigens on the surface of endothelium, that leads to the classical pathway of complement system activation resulting in inflammation development (acute rejection) and further vascular repair in the smallest blood vessels (chronic rejection) [9].…”