title: Double filtration plasmapheresis in antibody-incompatible kidney transplantation.
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.
authors.affiliation: Transplant Unit, University Hospitals Coventry and Warwickshire, Coventry, UK. robert.higgins@uhcw.nhs.uk
authors.forename: Rob
authors.initials: R
authors.lastname: Higgins
authors.forename: David
authors.initials: D
authors.lastname: Lowe
authors.forename: Mark
authors.initials: M
authors.lastname: Hathaway
authors.forename: For T
authors.initials: FT
authors.lastname: Lam
authors.forename: Habib
authors.initials: H
authors.lastname: Kashi
authors.forename: Lam Chin
authors.initials: LC
authors.lastname: Tan
authors.forename: Chris
authors.initials: C
authors.lastname: Imray
authors.forename: Simon
authors.initials: S
authors.lastname: Fletcher
authors.forename: Klaus
authors.initials: K
authors.lastname: Chen
authors.forename: Nithya
authors.initials: N
authors.lastname: Krishnan
authors.forename: Rizwan
authors.initials: R
authors.lastname: Hamer
authors.forename: Daniel
authors.initials: D
authors.lastname: Zehnder
authors.forename: David
authors.initials: D
authors.lastname: Briggs
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology; D000293:Adolescent; D000328:Adult; D000368:Aged; D001787:Blood Group Incompatibility / Q000276:immunology*; D005260:Female; D005374:Filtration; D005434:Flow Cytometry; D006084:Graft Rejection / Q000276:immunology; D006085:Graft Survival / Q000276:immunology; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis / Q000379:methods*; D055815:Young Adult
chemical_list: D000017:ABO Blood-Group System