Abstract: TH-PO816
Safety and Efficacy of Selective Plasma Exchange vs. Conventional Plasma Exchange in Pretransplant Desensitization of ABO-Incompatible Kidney Transplantation
Session Information
- Transplantation: Clinical - 2
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Inoue, Takahiro, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Japan
- Hanafusa, Norio, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan
- Kawaguchi, Yuki, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan
- Unagami, Kohei, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan
- Hoshino, Junichi, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan
- Ishida, Hideki, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan
- Takagi, Toshio, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan
- Tsuchiya, Ken, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan
Background
Selective Plasma Exchange (SePE) is a new simple PE modality that uses a membrane plasma separator with a smaller pore size compared to conventional plasma separators and enables removal of small and medium-sized molecules without removing larger substances such as coagulation factors. Conventional PE (CPE) supplemented with fresh frozen plasma (FFP) is performed preoperatively to reduce the risk of bleeding, but adverse events associated with FFP are common. Since July 2022, our institution has started SePE as a desensitization method before ABO-incompatible kidney transplantation.
Methods
This is a single-center, retrospective cohort study of patients undergoing ABO-incompatible kidney transplantation from January 2020 to April 2024. Seventy-five patients underwent apheresis for antibody removal prior to kidney transplantation and were divided into two groups: one undergoing CPE with FFP and the other undergoing SePE. The safety and efficacy of both groups were compared.
Results
In the CPE group, adverse events were observed in 17 cases, including four instances of anaphylactic shock. In the SePE group, hypotension was observed in five cases, but no serious adverse events were reported. Except for one case, preoperative antibody levels in both groups were reduced to less than 32 times the target. Although the surgical time was longer for the CPE group, there was no significant difference in intraoperative blood loss between the two groups.
Conclusion
Both groups showed adequate antibody removal, whereas the incidence of adverse events in the pretransplant desensitization of ABO-incompatible kidney transplantation was lower in the SePE group compared to the CPE group.
Clinical features and Outcome between SePE group and CPE group
| Patients undergoing kidney transplantation（N＝75) | SePE(N＝48) | CPE(N＝27) | P value |
| Age, years. | 51.1 ± 13.1 | 49.2 ± 13.8 | 0.568 |
| IgM (initial titers at admission) | 16.0 (8.0-16.0) | 16.0 (8.0-32.0) | 0.152 |
| IgM(titers at transplantation) | 2.0 (2.0-4.0) | 1.0 (1.0-2.0) | 0.006 |
| IgG (initial titers at admission) | 8.0 (2.0-16.0) | 64.0 (32.0-128.0) | 0.017 |
| IgG(titers at transplantation) | 2.0 (2.0-4.0) | 4.0 (2.0-16.0) | 0.007 |
| Surgical operating time, min. | 234.5 (213.0-280.0) | 274.0 (243.0-316.0) | 0.015 |
| Total blood loss, ml. | 200.0 (93.8-298.0) | 150.0 (80.5-292.5) | 0.811 |
| Patients experiencing adverse events during PE, n,％ | 5 (10.4) | 17 (63.0) | <0.001 |
| Anaphylactic shock, n, ％ | 0 (0) | 4 (14.8) | 0.027 |