Effect of Serial Sessions of Plasma Exchange on Blood Hemagglutinin Levels

Abstract

The most effective treatment of end stage renal disease is kidney transplantation, but donor shortage has significantly limited this treatment. This problem is even more in countries with poor deceased donor transplant programs and predominantly living-related donor transplant programs. To overcome this profound donor shortage, immunological barriers historically considered as absolute contraindications to transplantation are being reevaluated. One such barrier is the ABO blood group incompatibility (Magee, 2006). Kidney transplantation is best performed in the absence of (major) ABO incompatibility, a large end-stage kidney disease population and an increasing organ shortage result in waiting times for a deceased donor kidney transplant exceeding five years in some countries such as Germany. One possibility to reduce the waiting time is the transplantation across ABO antibody barriers. Theoretically, the number of kidney transplantations from living donors can be increased by up to 30% when patients are transplanted across the ABO antibody barrier (Becker et al., 2013). With currently existing protocols, as many as 90% of patients with an ABOi living donor may effectively be desensitized and transplanted. The aim of desensitization protocols is the reduction and maintenance of anti-A/B antibodies during the first two weeks after transplantation below a threshold that is considered to be safe. Thereafter, even when anti (A/B) antibodies recur at high levels they will not harm the kidney transplant, a phenomenon that is called accommodation. In recent years, graft survival rates after ABOi kidney transplantation nearly equaled those after ABO compatible (ABOc) procedures (Becker et al., 2013).