HLA항체 양성 환자에서 신장이식 전 혈장교환술의 항체 음성 전환 효과

Abstract

Background: Therapeutic plasma exchange (TPE) is used to remove antibodies from the blood stream, thereby preventing them from attacking their targets. We evaluated the strategies to increase the efficiency of TPE for renal allograft recipients with HLA antibody. Methods: A total of 11 patients were evaluated from January 2002 to April 2004. All the patients had been diagnosed with end stage renal disease (ESRD) and then they were scheduled for renal transplantation from a living unrelated donor or a living related donor. TPE was performed for all lymphocyte cross-matching (LCM) positive recipients before renal transplantation. One to three sessions of TPE were performed in 8 patients and four to seven sessions of TPE were performed in 3 patients (mean: 2.81 times). We used normal saline and 4% albumin as a replacement solution. Results: Eleven patients, after the patients' LCM positive serum converted to negative, received the renal transplantation. Of the 11 recipients, only 1 recipient suffered from chronic rejection. Ten recipients maintained normal renal function. Among the 11 recipients, 4 recipients were diagnosed with posttransplantation diabetes mellitus. 3 recipients had a past history of graft failure via acute or chronic rejection. Even these 3 recipients experienced successful renal allograft through pre-transplantation TPE. Also, all the recipients were followed up until June, 2005. Conclusion: For ESRD patients with positive LCM, pre-transplantation TPE dramatically decreases the incidence of acute or chronic rejections by converting positive LCM into negative LCM.