PLASMAPHERESIS IN HLA-IMMUNOSENSITIZED PATIENTS PRIOR TO KIDNEY-TRANSPLANTATION

Immunosensitization against the human lymphocyte antigen (HLA) is a pr oblem in most transplant centers. It prolongs the waiting list time in addition to risk of frequent acute rejections. To avoid these problem s, various pretransplantation approaches have been attempted e.g. plas mapheresis (PP). The present retrospective study reports our experienc e with PP in this respect over a 5 year period. Twenty-three chronic h emodialysis patiens with circulating panel reactive antibodies (greate r than or equal to 50%) and previous kidney graft rejections were trea ted with 12 PP each. in addition to this, immunosuppression with cyclo phosphamide and prednisolone were administered on the first day of PP and after tapering continued until transplantation. HLA-antibodies, as measured by the panel reactive antibodies and the antibody titer, dec reased. from about 70% to 30% (p<0.001) and 5 steps of titer-dilution, respectively with PP and immunosuppressive drugs; Twenty-two patients were transplanted with cadaveric grafts. Eight grafts were lost due t o irreversible rejection, and one due to the patient's death 2 months after transplantation. The cumulative five-year graft survival at the time of follow-up was 59%. Adequate kidney function (serum creatinine mean 150 mu mol/l) was observed in all grafts (n=3) still functioning 60 months posttraplant. We conclude that prestransplantation plasmaphe resis together with immunosuppressive drugs (cyclophosphamide and pred nisolone) is useful in the removal of HLA antibodies in immunized pati ents awaiting kidney transplantation. If can be considered a valuable approach to increase the chances of successful transplantations.