Therapeutic apheresis in renal transplantation: An update.
This update reviews the role of therapeutic apheresis as an adjunct to immunosuppression across renal transplantation, including ABO-incompatible transplantation, HLA desensitization, treatment of antibody-mediated rejection, and recurrent focal segmental glomerulosclerosis.
Background
Therapeutic apheresis plays a significant role in several aspects of renal transplantation by removing pathogenic antibodies and circulating proteins. Immunologic barriers such as ABO blood-group incompatibility and preformed donor-specific HLA antibodies can limit access to transplantation and graft survival, and apheresis techniques including plasma exchange and immunoadsorption are used to overcome them.
Key recommendations
Apheresis is a necessary preconditioning component for ABO-incompatible transplantation and an important modality for removing anti-HLA antibodies, both within desensitization protocols that allow highly sensitized candidates to be transplanted and as treatment for antibody-mediated rejection episodes after transplantation. It has also been used, with variable results, for the management of recurrent focal segmental glomerulosclerosis.
Clinical implications
Therapeutic apheresis is applied both before and after kidney transplantation as an adjunctive option to immunosuppressive agents, expanding the donor pool for sensitized and ABO-incompatible recipients and supporting graft survival. The review examines the evidence supporting these applications, recognizing that apheresis is typically combined with immunosuppression to achieve and maintain antibody reduction.
Category
Transplant
Source
Transfus Apher Sci
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