Plasmapheresis, immunosuppressive therapy and kidney transplant in a pre-sensitized patient
Cuéllar-Cabrera, H.; Ramírez-Fernández, M.; Guerra-Rosales, M.J.; Sánchez-Avila, M.A.
Boletin Medico del Hospital Infantil de Mexico 46(4): 246-250
1989
ISSN/ISBN: 0539-6115 PMID: 2655653 Document Number: 328260
An uremic patient with circulating antibodies against HLA Class I antigens and awaiting renal transplantation was treated with plasmapheresis three times weekly for 10 procedures. Prednisone (50 mg/24 h) and azathioprine (1 mg/kg/24 h) were started after the first plasma exchange. Each exchange fluid was replacement with 5% human albumin and frozen plasma. Except for transient leukopenia no complications were observed during the pretransplant treatment. Following treatment the positive crossmatches became negative and she was successfully transplanted with her father kidney. The graft functioned immediately with no hiperacute rejection and a mild episode on day 5 treated methyl prednisolone and three plasma exchange. Our patient is well with plasma creatinine of 0.7 mg/dL and a clearance of 60 mL/min three months after transplantation. This findings must be confirmed by others but identification and removal of anti-HLA antibodies is emerging as a promising method of dealing with the sensitized transplant recipient.