title: Extracorporeal immunomodulation (EIM) by plasmaleukapheresis (PLP) in the treatment of steroid resistant renal rejection.
abstract: We report the use of plasmaleukapheresis (PLP) to treat renal allograft rejection which had failed to respond to conventional pulse corticosteroid therapy. Twenty-three patients who failed to respond to at least 3 boluses of IV methylprednisolone received PLP. Sixteen of these patients had either complete (12) or partial (4) response to PLP. In the responding group, the mean serum creatinine was 1.5 +/- 0.3 mg/dl. In the partially responding group, the mean serum creatinine was 3.9 +/- 0.3 mg/dl. Plasmaleukapheresis resulted in the reduction in levels of circulating immune complexes (CIC), and T and B cells. Circulating null cell levels increased. All 5 patients with low (less than 10%) pretransplant cytotoxic antibody levels had complete response to plasmaleukapheresis. We conclude that PLP, perhaps by removal of CIC, antibody and/or population of circulating T or B cells, may be capable of reversing steroid resistant rejection, especially in patients with low levels of pretransplant cytotoxic antibodies.
mesh_terms: D000328:Adult; D000936:Antigen-Antibody Complex / Q000032:analysis; D005112:Extracorporeal Circulation; D005500:Follow-Up Studies; D006084:Graft Rejection; D006801:Humans; D007674:Kidney Diseases / Q000628:therapy; D016030:Kidney Transplantation; D007937:Leukapheresis; D010956:Plasmapheresis; D013601:T-Lymphocytes / Q000276:immunology
chemical_list: D000936:Antigen-Antibody Complex