Higgins, Rob, Lowe, David Philip, Hathaway, Mark, Lam, For T., Kashi, Habib, Tan, Lam Chin, Imray, C. (Chris), Fletcher, Simon, Chen, Klaus, Krishnan, Nithya, Hamer, Rizwan, Zehnder, Daniel and Briggs, David (2010) Double filtration plasmapheresis in antibody-incompatible kidney transplantation. Therapeutic Apheresis and Dialysis, Vol.14 (No.4). pp. 392-399. doi:10.1111/j.1744-9987.2010.00821.x

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Abstract

Double filtration plasmapheresis (DFPP) was used in preference to plasma exchange in our program of antibody-incompatible transplantation, to treat higher volumes of plasma. Forty-two patients had 259 sessions of DFPP, 201 pre-transplant and 58 post-transplant. At the first treatment session, the mean plasma volume treated was 3.81 L (range 3-6 L), 55.5 mL/kg (range 36.2-83.6 mL/kg). Serum IgG fell by mean 59.4% (SD 10.2%), and IgM by 69.3% (SD 16.1%). Nine patients did not require increases in plasma volumes treated, and six did not tolerate higher plasma volumes. In the remaining patients, the mean maximum plasma volume treated pre-transplant was 6.67 L (range 4-15 L), 96.1 mL/kg (range 60.2-208.9 mL/kg). The complement dependent cytotoxic crossmatch was positive in 14 cases pre-treatment, and remained positive in six (42.8%) cases. The flow cytometric crossmatch was positive in 29 cases pre-treatment, and in 21 (72.4%) after DFPP. Post-transplant, DFPP was ineffective at reducing donor specific antibody levels during periods of rapid donor specific antibody synthesis. Post-transplant, the one year graft survival rate was 94%, although there was a high rate of early rejection. In summary, DFPP enabled the treatment of plasma volumes that were almost double those that would have been feasible with plasma exchange. Despite this, most patients were transplanted with a positive crossmatch, and DFPP post-transplant was unable to control rising antibody levels.

Item Type:	Journal Article
Subjects:	R Medicine > RB Pathology R Medicine > RC Internal medicine
Divisions:	Faculty of Medicine > Warwick Medical School
Journal or Publication Title:	Therapeutic Apheresis and Dialysis
Publisher:	Wiley-Blackwell Publishing Asia
ISSN:	1744-9979
Official Date:	August 2010
Dates:	Date Event August 2010 Published
Volume:	Vol.14
Number:	No.4
Number of Pages:	8
Page Range:	pp. 392-399
DOI:	10.1111/j.1744-9987.2010.00821.x
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access

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