title: Cascade plasmapheresis as preconditioning regimen for ABO-incompatible renal transplantation: a single-center experience.
abstract: BACKGROUND
  Removal of anti-ABO is an important component of the preconditioning regimen for ABO-incompatible (ABOi) renal transplant. Cascade plasmapheresis (CP) is one of the extracorporeal methods of antibody removal, others being conventional plasma exchange (PE) and immunoadsorption. There is no previous published experience with CP in this context. The purpose of this study was to present an early experience with this approach.
  
  
  METHODS
  Consecutive ABOi renal transplant recipients in whom CP was used for pre- and posttransplant anti-ABO removal were included. All the patients received intravenous rituximab 2 weeks before transplant. After 1 week, CP was started along with oral tacrolimus and mycophenolate sodium. Alternate-day CP was done to attain immediate pretransplant antibody titer of not more than 8.
  
  
  RESULTS
  Fifteen ABOi renal transplant recipients had baseline (pretreatment) antibody titers ranging from 16 to 512. Desensitization rate was 100%. The mean number of procedures before transplant to achieve titer of not more than 8 was 3.27 ± 1.39. Patient survival was 93% and death-censored graft survival was 87%. Biopsy-proven acute rejection was seen in three patients (20%), one (6.67%) being acute antibody mediated rejection. The complication rate during CP was 4% and two patients had bleeding complication after surgery. Posttransplant infection rate was 13%.
  
  
  CONCLUSIONS
  Based on limited number of patients, we conclude that CP is a safe and effective extracorporeal method for pretransplant ABO antibody removal in patients undergoing ABOi transplant. Patients undergoing CP met target preoperative antibody titers and the clinical outcomes were acceptable.
authors.affiliation: Department of Nephrology.
authors.forename: Pranaw K
authors.initials: PK
authors.lastname: Jha
authors.affiliation: Department of Transfusion Medicine.
authors.forename: Aseem K
authors.initials: AK
authors.lastname: Tiwari
authors.affiliation: Department of Nephrology.
authors.forename: Shyam B
authors.initials: SB
authors.lastname: Bansal
authors.affiliation: Department of Nephrology.
authors.forename: Sidharth K
authors.initials: SK
authors.lastname: Sethi
authors.affiliation: Department of Urology, Medanta Institute of Kidney and Urology, Medanta, The Medicity, Gurgaon, Haryana, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Ahlawat
authors.affiliation: Department of Nephrology.
authors.forename: Vijay
authors.initials: V
authors.lastname: Kher
mesh_terms: D000017:ABO Blood-Group System / Q000097:blood / Q000276:immunology*; D000328:Adult; D000368:Aged; D001787:Blood Group Incompatibility / Q000097:blood / Q000276:immunology / Q000401:mortality; D002648:Child; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis / Q000009:adverse effects / Q000379:methods*; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult
chemical_list: D000017:ABO Blood-Group System; D007166:Immunosuppressive Agents