title: Therapeutic plasma exchange reduces ABO titers to permit ABO-incompatible renal transplantation.
abstract: BACKGROUND
  Thousands of patients with chronic renal failure die yearly without a kidney transplant due to the severe shortage of donors. Therapeutic plasma exchange (TPE) is performed to permit ABO-incompatible (ABO-I) kidney transplants, but little is known about how well TPE reduces ABO antibodies or complications related to TPE in this clinical setting.
  
  
  METHODS
  This retrospective study evaluated 46 individuals that received TPE to permit ABO-I kidney transplant. The number of TPE treatments was based on a goal ABO titer at the anti-human globulin (AHG) phase of 16 or less before surgery.
  
  
  RESULTS
  Before TPE, the median titer of recipient was 32 (range, 2-128) at room temperature (RT) phase and 64 (range, 4-1024) at AHG phase. The first TPE reduced the total agglutination reactivity score at AHG phase by 10.2 percent. Before transplantation, there was a mean of 6.2 +/- 2.5 TPE treatments and total agglutination reactivity score at AHG phase was reduced by 53.5 percent. The median titer remained reduced at 3 to 6 months after transplantation at 4 (range, 0-64) at RT phase and 8 (range, 1-64) at AHG phase. TPE complications were minimal. During at least one procedure, 15 (32.6%) individuals had either urticaria or pruritus, 18 (39.1%) individuals experienced mild citrate-induced hypocalcemia, 5 (10.2%) individuals had hypotension, 6 (13.0%) individuals had nausea or vomiting, and 1 (2.2%) individual had West Nile virus encephalitis.
  
  
  CONCLUSIONS
  With current infectious disease blood screening protocols, TPE has minimal complications and can reduce ABO antibody titers to permit ABO-I renal transplantation.
authors.affiliation: Transfusion Medicine Division, Department of Pathology, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA. atobian1@jhmi.edu
authors.forename: Aaron A R
authors.initials: AA
authors.lastname: Tobian
authors.forename: R Sue
authors.initials: RS
authors.lastname: Shirey
authors.forename: Robert A
authors.initials: RA
authors.lastname: Montgomery
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Tisch
authors.forename: Paul M
authors.initials: PM
authors.lastname: Ness
authors.forename: Karen E
authors.initials: KE
authors.lastname: King
mesh_terms: D000017:ABO Blood-Group System / Q000032:analysis / Q000276:immunology*; D001787:Blood Group Incompatibility / Q000276:immunology*; D006801:Humans; D016030:Kidney Transplantation; D010951:Plasma Exchange / Q000009:adverse effects; D012189:Retrospective Studies
chemical_list: D000017:ABO Blood-Group System