Successful ABO incompatible renal transplantation following rituximab and DFPP after failed immunoadsorption

Abstract

Effective antibody removal using PE, DFPP and IA has led to increased access to live donor organs through ABOi RT for patients with chronic kidney disease. However, there have been no head-to-head comparator studies between these modalities, and the choice of technique is usually influenced by cost and institutional preference. We describe the clinical course of a child undergoing ABOi RT, in whom IA without preconditioning with rituximab did not achieve a satisfactory reduction in the antibody titers, who went on to have a successful living donor RT following rituximab and DFPP.

Successful Treatment of Severe Psoriatic Arthritis and Psoriasis with Double Filtration Plasmapheresis

“…In DFPP, a first filter was used to separate plasma from blood (plasma separator) and a second to filter larger molecules from the plasma (plasma fractionator). Disease activity of the patients with autoimmune diseases could be controlled completely following the rapid depletion of specific disease-associated plasma factors [20][21][22][23][24][25][26][27].…”

Plasmapheresis Therapy in Kidney Transplant Rejection

“…The use of peritransplant treatments to reduce the level of preformed alloantibodies has been established as a clinically viable option to improve access for highly sensitized patients in living donor transplantation [24][25][26]. Desensitization protocols typically include TPE or IVIG (high dose: 2 g/kg or low dose: 100 mg/kg) or both and rituximab to downregulate antibody-mediated immune responses [27,28]. Clinically, the number of TPE or IVIG treatments or both is influenced by both the antibody levels and the degree of mismatch.…”

ABO‐incompatible liver transplantation: Is it a viable option with modern innovation?

“…Although infrequently implemented in recent years given high association with catheter‐related problems including hepatic hilar vascular thrombosis, the application of local infusion treatment demonstrated increased patient survival following ABO‐ILT . The advent of extracorporeal therapies, including TPE, DFP, and antigen‐specific immunoadsorption, enable depletion of resident IHs, reducing the chance of AMR . DFP and immunoadsorption have been developed in an attempt to selectively deplete anti‐A and anti‐B IHs void of the disadvantages linked to TPE including hypersensitivity, citrate toxicity, and hemodynamic stress .…”

“…10 In Korea, IH titer reduction is primarily achieved through therapeutic plasma exchange (TPE); however, Japan has recently developed double-filtration plasmapheresis (DFP) as a means to overcome the drawbacks associated with TPE. 10,13 Although the direct infusion of antiinflammatory drugs through a portal vein or hepatic artery catheter for reducing local inflammation was once regarded as an essential component of the DSV protocol, the increasing use of rituximab, a monoclonal anti-CD20 antibody suppressing B lymphocyte differentiation, has fostered clinical success without local graft infusion therapy and its incidental complications of bleeding and vascular thrombosis. 10,12 Rituximab has further replaced the necessity of surgical intervention in the form of splenectomy to prevent a posttransplant rebound rise of IHs.…”