Clinical effects of double filtration plasmapheresis for sensitized recipients of cadaver kidney transplantation

Objective To investigate the clinical efficacy and safety of double filtration plasmapheresis (DFPP) pretreatment combined with CD25 monoclonal antibody inducible therapy for sensitized recipients of cadaver kidney transplantation.Method The clinical data of 45 sensitized recipients who received the pretreatment with DFPP and CD25 monoclonal antibody from November 2011 to January 2012 were retrospectively analyzed.Panel reactive antibody (PRA) was examined by using ELISA.Before the DFPP combined with CD25 monoclonal antibody,the PRA was (56.5 ± 19.9) ％ (＞ 20％),and after the pretreatment,the PRA level was decreased to (18.9 ± 19.1)％.HLA mismatch of recipients and donators was (2.1 ± 0.7),and the lymphocytotoxic crossmatch tests before operation were negative.The incidence of patient/kidney survival,transplantation rejection and pulmonary infection were observed.All the patients were followed up for 12 months.Result During the follow-up period,no patient died,and transplanted kidney dysfunction occurred in 2/45 recipients.Twelve months after months,the survival rate was 100％ and transplanted kidney survival rate was 95.6％ (43/45).One (2.2％) of 45 recipients had hyperacute rejection during the operation,and was given plasmapheresis after the resection of the transplanted kidney.Twelve (26.7％) of 45 recipients had acute rejection:11 recipients completely recovered after methylprednisolone and ATG therapy,and 1 recipient given plasmapheresis for kidney dysfunction.Four (8.9％) had the pulmonary infection after operation,and all of them recovered after antiinflammation treatment.Conclusion DFPP pretreatment before kidney transplantation combined with CD25 monoclonal antibody inducible therapy is safe and effective,specially for sensitized recipients. Key words: Kidney transplantation;  Sensitized recipients;  Plasma exchange;  Induction therapy