Role of therapeutic plasma exchange in reducing ABO titers in patients undergoing ABO-incompatible renal transplant

Abstract

Abstract Background/aims Our study presents an analysis of the trends of ABO antibody titers and the TPE (therapeutic plasma exchange) procedures required pre- and post-ABO-incompatible renal transplant. Methods Twenty-nine patients underwent ABO-incompatible renal transplant during the study period. The ABO antibody titers were done using the tube technique and titer reported was the dilution at which 1+ reaction was observed. The baseline titers of anti-A and anti-B antibodies were determined. The titer targeted was ≤8. Patients were subjected to 1 plasma volume exchange with 5% albumin and 2 units of AB group FFP (fresh frozen plasma) in each sitting. TPE procedures posttransplant were decided on the basis of rising antibody titer with/without graft dysfunction. Results The average number of TPE procedures required were 4–5procedures/patient in the pretransplant and 2–3procedures/patient in the posttransplant period. An average titer reduction of 1serial dilution/procedure was noted for anti-A and 1.1serial dilution/procedure for anti-B. Number of procedures required to reach the target titer was not significantly different for anti-A and anti-B ( p =0.9). The number of TPE procedures required pretransplant does not differ significantly with the baseline titers ( p =0.062). Outcome of the transplant did not differ significantly by reducing titers to p =0.326). The difference in the anti-A and anti-B titers at 14th day posttransplant was not found to be clinically significant ( p =0.19). Conclusion With an average of 4–5 TPE procedures pretransplant and 2–3 TPE procedures posttransplants, ABO-incompatible renal transplantations can be successfully accomplished.