SAT-083 SAFETY OF HEMODIALYSIS AND APHERESIS COMBINATION THERAPY AT PRE-TRANSPLANT DESENSITIZATION OF ABO-INCOMPATIBLE KIDNEY TRANSPLANTATION

Abstract

In patients requiring both hemodialysis (HD) and apheresis, the two treatments can be performed simultaneously. At our hospital, apheresis is often performed along with HD for isoagglutinins removal before ABO-incompatible kidney transplantation. The two treatments can be completed within the HD schedule, which allows the treatment time to be shortened. This approach is also less stressful for patients because fewer punctures are required. In this study, we investigated the safety of HD and apheresis combination therapy. A total of 130 apheresis sessions in 37 ABO-incompatible kidney transplantation recipients between 2015 and 2018 were investigated. Differences in the time changes of arterial pressure, venous pressure, filtration pressure and transmembrane pressure (TMP) were examined in patients treated with combination therapy (Group C, n=90) and apheresis monotherapy (Group M, n=40). In combination therapy, after HD was initiated, apheresis treatment was started by connecting the apheresis circuit, and the same volume as the priming volume (100 to 200 ml) was added. The apheresis circuit was connected to the blood removal side sample port of the HD circuit and the liquid level adjustment line of the arterial chamber. Heparin was administered from the dialysis circuit alone by increasing the dose. Nafamostat mesylate was administered from both the dialysis and apheresis circuits. The blood was returned after apheresis treatment, and the apheresis circuit was disconnected. The two groups were compared using a mixed effects model (random effects) with adjustment of background factors (anticoagulant, machinery used, treatment mode, blood flow rate, filtration rate). Statistical analysis was performed using the R Ver. 3.3.2 rms package. The internal pressures were higher in Group C, but there were no significant differences in time changes compared to Group M and no functional problems (C vs. M for interaction, arterial pressure, venous pressure, filtration pressure, and TMP: P=0.337, 0.725, 0.222 and 0.498, respectively). Membrane exchange was required in one case in Group C due to coagulation. There were no differences in the rates of decrease of isoagglutinin titers between the two groups, and no case had antibody-mediated rejection after transplantation. In HD and apheresis combination therapy, care is required when securing vascular access for adequate removal of blood, establishing an effective blood flow, selecting the appropriate anticoagulant and administration method, and choosing the method of monitoring of circuit internal pressures. Provided that these approaches are performed correctly, our results suggest that combination therapy can be performed without any functional problems, compared to apheresis monotherapy.