Evaluation of long-term efficacy of plasma exchange and double-filtration plasmapheresis preprocessing in high-titer ABO-incompatible kidney transplantation
10.12464/j.issn.1674-7445.2025253
- VernacularTitle:针对高滴度ABO血型不相容肾移植血浆置换与双重滤过血浆置换预处理的远期疗效评价
- Author:
Lifei LIANG
1
;
Guisheng QI
2
;
Rong ZHOU
3
;
Ruirui SANG
3
;
Cheng YANG
4
Author Information
1. Department of Kidney Transplantation, Zhongshan Hospital Affiliated Fudan University, Shanghai 200032, China;.
2. Department of Kidney Transplantation, Zhongshan Hospital Affiliated Fudan University, Shanghai 200032, China.
3. .
4. Department of Kidney Transplantation, Zhongshan Hospital Affiliated Fudan University, Shanghai 200032, China;;.
- Publication Type:OriginalArticle
- Keywords:
ABO-incompatible kidney transplantation;
Plasma exchange;
Double-filtration plasmapheresis;
Blood type antibody titer;
Graft survival rate;
Chronic kidney disease;
Hemodialysis;
Peritoneal dialysis
- From:
Organ Transplantation
2026;17(1):68-76
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the clinical efficacy of plasma exchange (PE) and double-filtration plasmapheresis (DFPP) pretreatment regimens for high-titer ABO-incompatible kidney transplantation (ABOi-KT). Methods A retrospective analysis was conducted on 31 cases of ABOi-KT with a follow-up period ≥1 year admitted to Zhongshan Hospital Affiliated to Fudan University from April 2016 to August 2025. The efficacy differences between the PE combined with rituximab (RTX) + oral triple immunosuppressive regimen and the DFPP combined with RTX + oral triple immunosuppressive regimen were compared and analyzed. The titers of blood group antibodies and serum creatinine levels before and after the operation were monitored. The survival curves and cumulative risk occurrence curves were plotted using the Kaplan-Meier method. The survival rates of recipients and transplanted kidneys and the occurrence of complications were analyzed. Results Both the PE regimen and the DFPP regimen may effectively reduce the preoperative blood group antibody titer of the recipients to ≤1∶16. The one-year survival rate of the recipients and the transplanted kidneys both reached 100% after the operation. The postoperative serum creatinine levels of recipients who received the DFPP regimen were lower and more stable. There was no statistically significant difference in the incidence of complications between the two regimens during the same follow-up period. Conclusions Both the PE and DFPP regimens are effective pretreatment regimens for ABOi-KT. The DFPP regimen has more advantages in reducing treatment operations, lowering drug dosage and maintaining the stability of postoperative renal function. For recipients with a high initial antibody titer (≥ 1∶32), individualized determination of the number and frequency of plasma processing for pretreatment may achieve ideal therapeutic effects.
