Plasmapheresis in combined treatment of acute rejection crises after kidney transplantation

: The aim of the study was assessment of effectiveness and safety of extracorporeal procedures (plasmapheresis) in prevention and combined treatment of acute rejection crises (ARC) after kidney transplantation in patients at high risk to develop acute immunological conflicts in early postoperative period. 94 patients aged 21-56 years after allotransplantation of cadaver kidney (ATCK) entered the study. They were divided into two groups: group 1 patients (n = 47) received plasmapheresis procedures in combined preventive and therapeutic treatment of ARC; matched group 2 patients (n = 47, retrospective) received the same therapy but plasmapheresis. In both groups there were many patients with a high titer of pre-existing antibodies and massive hemotransfusions in the past. The analysis covered also recipients with the second ATCK (9 and 4 patients, respectively). After ATCK both groups received three-component immunosuppressive treatment (neoral, prednisolone, azatioprin and/or sell-cept). The analysis of the transplant and recipient 11-month survival has estimated that it was 93.6 and 91.5% for the recipients, respectively, and 91.5 and 76.5% for the transplanted kidney for group 1 and 2, respectively. The conclusion is that plasmapheresis in combined prevention and treatment of ARC by humoral type in sensitized patients (high titer of the pre-existing antibodies, repeat transplantations, hemotransfusions) is pathogenetically grounded and lowers the percentage of irreversible episodes of acute transplant rejection early after surgery.