Keywords : ABO Blood type incompatible kidney transplantation
Therapeutic plasmapheresis in kidney transplant patients: 30 years experience
European Journal of Molecular & Clinical Medicine,
2022, Volume 9, Issue 2, Pages 1089-1097
This retrospective observational study illustrates 30 years of experience of Therapeutic Plasma Exchange in 35 cases out of 1210 kidney transplantations performed between 1990 till 2020. Total 11 patients underwent Plex before undergoing kidney transplantation whereas 24 patients underwent Plex post kidney transplantation. Pre-transplant therapeutic plasma exchange was done in 5 Human Leukocyte Antigen incompatible, 5 ABO incompatible kidney transplant prospects and 1 prospective recipient with monoclonal gammopathy of renal significance. Whereas 15 kidney transplant recipients (Kidney Transplant Recipients) with antibody mediated rejection, 6 Kidney Transplant Recipients with thrombotic microangiopathy, 1 with myeloma cast nephropathy, 1 recurrence of Focal Segmental Glomerulosclerosis post transplantation & 1 Anti-Glomerular Basement Membrane antibody positive Kidney Transplant Recipient underwent Plex. The clinical end point after Plex exchange was achieved in 23 patients, 6 patients had a partial response. There was no response after Plex done for Kidney Transplant Recipient with Anti-Glomerular Basement Membrane antibody positive transplant glomerulopathy who subsequently progressed to requiring maintenance dialysis. One patient undergoing Human Leukocyte Antigen incompatible kidney transplant developed hyper acute rejection & had to undergo graft nephrectomy and another case with myeloma light chain cast nephropathy could not be salvaged. Pre-transplant Therapeutic Plasma Exchange used for desensitization of ABO incompatible & Human Leukocyte Antigen incompatible kidney transplants has benefitted 9 out of 10 patients in our study. Patient with end stage renal disease due to monoclonal gammopathy of renal significance was ultimately able to undergo kidney transplantation due to complete response after Therapeutic Plasma Exchange. Notably, we observed partial response for stabilizing chronic Antibody Mediated Rejection and late acute Antibody Mediated Rejection. Pathogenic entities like anti-endothelial cell antibody, thrombotic microangiopathy causing graft dysfunction can be successfully managed by Therapeutic Plasma Exchange. Therapeutic Plasma Exchange for the treatment of recurrence of Focal Segmental Glomerulosclerosis (focal segmental glomerulosclerosis) after kidney transplant has shown a partial response in terms of reduction in proteinuria.