Role of double-filtration plasmapheresis in ABO- and human leukocyte antigen-incompatible kidney transplant

Abstract

Kidney transplant has significantly improved the quality of life in end-stage renal disease patients compared to maintenance hemodialysis. Recipients can receive a living-donor or a deceased-donor kidney transplant. However, the presence of donor specific anti human leukocyte antigen (HLA) antibodies or anti A or B antibodies in the recipient makes the transplant incompatible and provokes to cause hyperacute, acute, or chronic rejection. Desensitization which is usually applied before to reduce incompatibility can be achieved by apheresis and preventing donor-specific antibody resynthesis by targeting both T and B cells. Here, we present two such cases transplanted successfully by desensitizing with double-filtration plasmapheresis (DFPP). Case 1 which was a female with high-titer anti-HLA antibody was managed with rituximab, 4 sessions of DFPP, antithymocyte globulin, and posttransplant Tacrolimus (Tac). Case 2 who had both high-titer anti-HLA and anti-A (IgG 1:256) antibody was managed with rituximab, 3 sessions of DFPP, and posttransplant Tac. In both cases, perioperative complications due to DFPP such as bleeding, thrombocytopenia, hypotension, and need of transfusion was minimal. These cases point toward successful application of DFPP in desensitization protocol, leading to successful HLA antibody-incompatible and ABO-incompatible renal transplant with minimal adverse incident and cost.

Keywords

• double-filtration plasmapheresis
• double-filtration plasmapheresis in abo-incompatible kidney transplant
• double-filtration plasmapheresis in human leukocyte antigen-incompatible kidney transplant