Apheresis in the Treatment of Antibody-Mediated Acute Renal Graft Rejection

Abstract

Basic indications for the use of apheresis in the treatment of antibody-mediated acute rejection include: (i) resistance to conventional anti-rejection therapy; (ii) poor prognosis for the graft; (iii) the need for a rapid removal of antibodies from the circulation, since their half-life is of about 3 weeks. Despite the large number of cases already reported in the literature, the role of apheresis in the treatment of acute rejection is still a matter of discussion. This is due to the difficulties in drawing definitive conclusions on its effectiveness for the lack of large controlled trials as well as for the variability in treatment schedules and the associated drug therapy. However, in many transplant centers apheresis is currently used to treat antibody-mediated acute rejection. The criteria for an appropriate use of apheresis in these settings are: (i) a prompt diagnosis of antibody-mediated rejection by means of graft biopsy; (ii) starting apheresis as soon as possible after diagnosis, and before irreversible damage of the graft occurs, without waiting for failure of drug therapy; (iii) the association with immunosuppressive agents effective on antibody production.