Login to Access Video or Poster Abstract: MP74-11
Sources of Funding: None

Introduction

For successful kidney transplantation, patients who are at immunological high risk, such as those who have an ABO blood type incompatibility with the donor and/or who are positive for donor specific anti-HLA antibodies, should undergo apheresis therapy. For apheresis therapy, immunoadsorption, double filtration plasmapheresis (DFPP), or plasma exchange is often performed. Plasma exchange using fresh-frozen plasma (FFP) often causes unpleasant adverse events. However, there are few reports on the incidence and profile of adverse events during therapeutic plasma exchange in kidney transplant recipients.

Methods

From April 2005, 53 kidney transplant recipients (including 6 preemptive cases) at immunological high risk were enrolled in this study. For desensitization, they underwent three or four sessions of apheresis therapy (two or three sessions of DFPP and one or two sessions of plasma exchange). They also received a single dose of rituximab at 200 mg/body 3 weeks before transplantation. The induction immunosuppressive therapy consisted of tacrolimus, mycophenolate mofetil, steroid, and basiliximab. All patients with antibody-mediated rejection (ABMR) received apheresis therapy (plasma exchange or DFPP), steroid pulse therapy, and administration of low-dose (100 mg/kg) immunoglobulin intravenously for 3 to 5 days. Three liters of FFP equivalent to the total plasma volume in each patient was used during each session of plasma exchange. We evaluated adverse events during 88 sessions of plasma exchange (62 sessions, including 12 sessions combined with hemodialysis preoperatively, and 26 sessions for ABMR). Adverse events were evaluated by the Common Terminology Criteria for Adverse Events Version 4.0.

Results

The incidence of adverse events was 83% (73/88). The principal events were pruritus 53% (47/88), numbness (hypocalcemic symptoms) 40% (35/88), urticaria 33% (29/88), chill 19% (17/88), nausea and vomiting 13% (11/88), mild dyspnea 5% (4/88), and mild hypotension 3% (3/88). Severe adverse events (grade 3 or over) were not recorded. The incidence of adverse events was significantly higher at pretransplantation than at posttransplantation (p < 0.001). No differences were found in the incidence of adverse events between preemptive cases and patients receiving maintenance dialysis. The incidence of numbness during plasma exchange was significantly less (p = 0.009) in patients receiving combined hemodialysis than in those not receiving hemodialysis.

Conclusions

During therapeutic plasma exchange using FFP in kidney transplant recipients, pruritus, numbness, and urticaria commonly occur. In patients with chronic renal failure, plasma exchange combined hemodialysis may be useful to prevent numbness. The incidence and severity of adverse events during plasma exchange may be associated with kidney function.

Funding

None