BACKGROUND: Elimination of preexisting IgG antibodies against donor antigen is an important role before antibody-incompatible (i.e. ABO-incompatible and donor-specific antibody positive) kidney transplantation. Plasma exchange (PEx) has risks of hyperacute allergic reactions and microorganism transmission caused by using fresh frozen plasma. Another apheresis, Double filtration plasmapheresis (DFPP) using albumin solution removes antibodies effectively, however, fibrinogen (Fib) is massively removed resulting in hemostasis failure. Here, we created a modified combination of filtrating membranes in DFPP (modified DFPP, mDFPP) to retain more Fib while removing IgG, and assessed its efficacy and safety in comparison with conventional DFPP (cDFPP).

METHODS: Patients who underwent antibody-incompatible kidney transplantation were enrolled in this retrospective study. We used Plasmaflo® OP-08W in cDFPP and Cascadeflo® EC-50W, whose pore size is smaller than OP-08W to filtrate Fib back to patient's plasma, in mDFPP as a primary plasma separator, respectively. Cascadeflo® EC-20W was used as a secondary separator in both DFPP. Removal rates (RR) of IgG antibodies and Fib after each DFPP per session were compared between cDFPP and mDFPP. Incidence of adverse events during and after each DFPP was compared between the groups.

RESULTS: cDFPP and mDFPP were performed in 23 and 10 cases, respectively. The patient's clinical backgrounds were similar between the groups. RR of IgG was significantly lower in mDFPP group than cDFPP group (62.1±6.7% vs 74.6±9.6%, p<0.001). Loss rate of Fib was significantly lower in mDFPP than in cDFPP (38.1±11.5% vs 75.5±5.3%, p<0.001). Regarding adverse events, there was no hypotension event observed during or immediately after either DFPP treatment, however, incidence of hemostasis prolongation of arteriovenous fistula was significantly higher in cDFPP group (81.8%) than in mDFPP group (12.5%). This result suggested that mDFPP preserve more Fib than cDFPP, resulting in better hemostasis.

CONCLUSIONS: mDFPP can remove IgG more selectively with removal rate of 60% while preserving Fib with loss rate of 40%. mDFPP is efficacious and safe apheresis to remove donor-reactive antibody before transplant.

CITATION INFORMATION: Iwami D., Matsumoto T., Hotta K., Ota M., Chiba Y., Higuchi H., Shinohara N. modified DFPP Can Eliminate Donor-Reactive IgG Antibody with Preserving Fibrinogen before Kidney Transplantation Am J Transplant. 2017;17 (suppl 3).

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