Treatment of acute vascular rejection with immunoadsorption.

Background Acute vascular rejection (AVR) is characterized by vascular injury and systolic graft dysfunction and is often associated with elevated panel reactive antibodies (PRAs) to HLA antigens. Plasmapheresis has been shown to improve the otherwise poor prognosis of AVR, but its use is often complicated and limited by hypotension. Methods and Results In three cardiac transplant recipients with severe hemodynamic compromise during AVR, refractory to standard therapy, extracorporeal immunoadsorption was performed using a protein A column. Plasma was removed at 10 to 20 cm 3 /min, passed through the column, and reinfused. All three patients had negative pretransplant PRAs