Plasmapheresis in Chronic Active Antibody-Mediated Rejection

Plasmapheresis can be utilized as an adjunct to other methods to desensitize highly-sensitized potential renal transplant recipients or in the case of potential renal transplant recipients with ABO incompatible donors and for the treatment of acute humoral rejections, recurrent focal segmental glomerulosclerosis and thrombotic microangiopathy. In this report, we present our experience with plasmapheresis in two cases of chronic active antibody-mediated rejection. We performed five sessions of plasmapheresis and administered intravenous Ig (IVIg) 10 gr after each plasmapheresis in these cases and found that renal functions improved after the treatment. Chronic active antibody-mediated rejection (CAAR) is difficult to treat and has a negative effect on graft survival. There have been few studies on a limited number of patients treated with a combination of rituximab and IVIg. There is limited knowledge about effects of plasmapheresis on CAAR. Based on treatment outcomes obtained in the two cases presented here, it can be emphasized that plasmapheresis is one of the most important treatment alternatives in CAAR, a condition that affects graft survival.