Therapeutic plasma exchange reduces ABO titers to permit ABO-incompatible renal transplantation

Authors: Tobian, Aaron A.R.; Shirey, R. Sue; Montgomery, Robert A.; Tisch, Daniel J.; Ness, Paul M.; King, Karen E.

Source: Transfusion, Volume 49, Number 6, June 2009 , pp. 1248-1254(7)

Publisher: Wiley-Blackwell

Abstract:

BACKGROUND:

Thousands of patients with chronic renal failure die yearly without a kidney transplant due to the severe shortage of donors. Therapeutic plasma exchange (TPE) is performed to permit ABO-incompatible (ABO-I) kidney transplants, but little is known about how well TPE reduces ABO antibodies or complications related to TPE in this clinical setting. STUDY DESIGN AND METHODS:

This retrospective study evaluated 46 individuals that received TPE to permit ABO-I kidney transplant. The number of TPE treatments was based on a goal ABO titer at the anti-human globulin (AHG) phase of 16 or less before surgery. RESULTS:

Before TPE, the median titer of recipient was 32 (range, 2-128) at room temperature (RT) phase and 64 (range, 4-1024) at AHG phase. The first TPE reduced the total agglutination reactivity score at AHG phase by 10.2 percent. Before transplantation, there was a mean of 6.2 ± 2.5 TPE treatments and total agglutination reactivity score at AHG phase was reduced by 53.5 percent. The median titer remained reduced at 3 to 6 months after transplantation at 4 (range, 0-64) at RT phase and 8 (range, 1-64) at AHG phase. TPE complications were minimal. During at least one procedure, 15 (32.6%) individuals had either urticaria or pruritis, 18 (39.1%) individuals experienced mild citrate-induced hypocalcemia, 5 (10.2%) individuals had hypotension, 6 (13.0%) individuals had nausea or vomiting, and 1 (2.2%) individual had West Nile virus encephalitis. CONCLUSIONS:

With current infectious disease blood screening protocols, TPE has minimal complications and can reduce ABO antibody titers to permit ABO-I renal transplantation.

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1537-2995.2008.02085.x

Publication date: 2009-06-01

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