Diagnosis: Use of Apheresis for Desensitization of Positive Crossmatch Renal Transplants
• The American Society for Apheresis (ASFA) has published evidence-based guidelines for the use of therapeutic apheresis in various disorders.
• Each disorder is assigned a category (i.e., I to IV) and strength of recommendation.
• Therapeutic plasma exchange (TPE) has been shown to be a second-line therapy, either alone or in conjunction with other immunosuppressive therapy, to desensitize patients with a positive crossmatch to a living donor kidney caused by donor-specific human leukocyte antigen (HLA) antibodies.
• Immunosuppressive medications, either alone or in combination with therapeutic plasmapheresis, high-dose intravenous immunoglobulin (IVIg), and/or rituximab, can be used to prevent and treat antibody-mediated rejection.
• Patients may develop anti-HLA antibodies through prior transfusions, pregnancies, and/or transplantation.
• Removal of donor specific HLA antibodies prior to transplantation could enable a negative crossmatch and prevent hyperacute/acute rejection.
• Posttransplant immunosuppression can prevent loss of the organ caused by an anamnestic response.
