SAT-084 DIFFERENCE IN RATE OF DECLINE OF ISOAGGLUTININ TITERS BETWEEN SELECTIVE PLASMA EXCHANGE WITH AND WUTHOUT FRESH FROZEN PLASMA BEFORE ABO-INCOMPATIBLE KIDNEY TRANSPLANTATION

Abstract

Isoagglutinins removal by apheresis and immunosuppressive therapy are generally performed at pre-transplant desensitization of ABO-incompatible kidney transplantation. Selective plasma exchange (SePE) is a new simple plasma exchange (PE) modality that enables removal of small and medium-sized molecules without removing larger molecules, such as coagulation factors. Since 2015, we have always performed SePE using albumin solution in patients with a low isoagglutinin titers, or we added this approach in patients in whom the isoagglutinin titers was sufficiently decreased by double-filtration plasmapheresis (DFPP) and/or simple PE. However, although this procedure is advantageous in that it has fewer adverse effects, it also removes about 30% of coagulation factors, such as fibrinogen and factor XIII, and this is problematic in the perioperative period. Thus, we currently perform SePE using fresh frozen plasma (FFP) as part of the replacement fluid in patients with a decline of coagulation factors. We have had a favorable impression clinically with regard to the decline of the antibody titer with use of FFP. In this study, we examined if this impression was supported by a significant difference in outcomes.