Plasma Exchange in Acute Renal Allograft Rejection

Nh, Allen; Dyer, Phil; Geoghegan, Tony; Harris, K.R.; Ha, Lee; Slapak, M

doi:10.1097/00007890-198305000-00006

Cited by 69 publications

(21 citation statements)

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“…As antidonor–antibodies mediate allograft rejection, their removal should improve the results. Plasmapheresis was used to remove these Ab in several studies, but the data are conflicting (5–9 and others). Immunoadsorption is the most efficient technique available for Ab removal.…”

Section: Discussionmentioning

confidence: 99%

Immunoadsorption of sensitized kidney transplant candidates immediately prior to surgery

Hickstein

Korten

Bast

et al. 2002

Clinical Transplantation

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Patients with anti-human leucocyte antigen (HLA) antibodies from previous transplantation, blood transfusion are highly sensitized and at risk to hyperacute renal graft loss. As these antibodies are identified to be of pathogenic importance, an effective removal may allow successful transplantation. Six 'high risk patients' [panel-reactive antibodies (PRA) >30% or retransplanted patients with an acutely rejected first graft within 6 months from surgery] were treated by protein A immunoadsorption (IA) immediately prior to transplantation. We treated the calculated plasma volume one to three times prior to surgery: mean 4600 mL (range 2100-10 200 mL). After transplantation we repeated the sessions according to antibody (Ab) recurrence, graft function and signs of rejection. The panel reactive Ab were reduced from mean 65% pre-IA (range 35-85) to lowest 15% (range 0-55). After the course they reappeared to 30% (range 0-90). Five of the six patients had no clinical signs of vascular rejection. At a follow-up of mean 54 months (+/-14) four grafts still function with a mean serum creatinine of 172 micromol/L (+/-57). Protein A IA is a safe and effective adjunct in the treatment of highly sensitized patients awaiting renal transplantation. The treatment immediately prior to operation can prevent hyperacute rejection and increases the graft survival in these patients.

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Section: Discussionmentioning

confidence: 99%

Immunoadsorption of sensitized kidney transplant candidates immediately prior to surgery

Hickstein

Korten

Bast

et al. 2002

Clinical Transplantation

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show abstract

“…To our knowledge, only one controlled trial of plasmapheresis has been done [16]. This study, published by Allen et al, included in the treatment arm 13 patients maintained on azathioprine and prednisone who developed steroid resistant rejection.…”

Section: Discussionmentioning

confidence: 99%

Treatment of antibody-mediated accelerated rejection using plasmapheresis

et al. 2000

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“…Most are retrospective analyses, with small numbers of patients (mean 12, range 5 -5 1 ) and only 2 are controlled trials [3,5]. The 251 patients can be divided into 229 with acute steroid resistant rejection, which was biopsy proven in 141 [1-6, 8, 9, 11-13, 15]; 17 with chronic vascular rejection (CVR), which was biopsy proven in 11 patients [2,6]; 2 with unclassified lesions on biopsy; and 3 with interstitial nephritis.…”

Section: Discussionmentioning

confidence: 99%

“…Options are anti-thymocyte globulin (ATG), anti-lymphocyte globulin (ALG) and OKT3. Newer monoclonal antibodies and plasma exchange are reported in adults [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] but not children. We describe the use of plasma exchange in six children with acute renal allograft rejection that was resistant to steroids and ATG.…”

Section: Introductionmentioning

confidence: 99%