Background: Selective plasma exchange (SePE) is a new simple plasma exchange (PE) modality that enables\nremoval of small and medium-sized molecules without removing larger substances such as coagulation factors.\nIn this study, we examined the efficacy of SePE for removal of isoagglutinins in pre-transplant desensitization for\nABO-incompatible (ABOi) kidney transplantation.\nMaterials and methods: A case series study was performed in 15 ABOi kidney transplant recipients (KTRs) who\nunderwent SePE alone (7 cases) and SePE in combination with double-filtration plasmapheresis or simple plasma\nexchange (8 cases). The target processed plasma volume (PV) was set at 2 PV, and 5% albumin solution was used\nas the substitution fluid in all SePE sessions. Changes in isoagglutinin titers (IgG and IgM) and serum IgG, IgM,\nand fibrinogen levels were examined. We also compared the decrease in isoagglutinin titers between SePE and\nconventional methods (PE and double-filtration plasmapheresis).\nResults: A total of 29 sessions of SePE were performed in the 15 KTRs. Isoagglutinin titers were controlled to greater than equal to 1:16 in\nall patients except for 2 with high isoagglutinin titers, and there were no cases of antibody-mediated rejection. SePE\nled to a median twofold decrease in isoagglutinin titers (IgG and IgM), with median IgG, IgM, and fibrinogen removal\nrates of 64.2, 11.7, and 25.5%, respectively. Side effects occurred in only 4 of the 29 sessions. Neither titer decreased\nafter SePE in 30% of the sessions. However, the reductions in isoagglutinin titers in patients undergoing SePE were\nsignificantly less than those in patients treated with conventional methods.\nConclusion: Because SePE is less efficient in removing isoagglutinins compared to conventional methods, the use of\nSePE alone should be limited to patients with low isoagglutinin titers, and SePE in combination with conventional\nmethods should be used for patients with high isoagglutinin titers. SePE may be a useful treatment option, if applied\nin appropriate cases, due to its lower cost (about half the price of PE using fresh frozen plasma in Japan) and fewer\nside effects. However, care is required because about 25% of fibrinogen is removed during SePE.
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