الفهرس 
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Abstract
Summary
The most effective treatment of end stage renal disease is kidney transplantation, but donor shortage has significantly limited this treatment. This problem is even more in countries with poor deceased donor transplant programs and predominantly living-related donor transplant programs. To overcome this profound donor shortage, immunological barriers historically considered as absolute contraindications to transplantation are being reevaluated. One such barrier is the ABO blood group incompatibility (Magee, 2006).
Kidney transplantation is best performed in the absence of (major) ABO incompatibility, a large end-stage kidney disease population and an increasing organ shortage result in waiting times for a deceased donor kidney transplant exceeding five years in some countries such as Germany. One possibility to reduce the waiting time is the transplantation across ABO antibody barriers. Theoretically, the number of kidney transplantations from living donors can be increased by up to 30% when patients are transplanted across the ABO antibody barrier (Becker et al., 2013).
With currently existing protocols, as many as 90% of patients with an ABOi living donor may effectively be desensitized and transplanted. The aim of desensitization protocols is the reduction and maintenance of anti-A/B antibodies during the first two weeks after transplantation below a threshold that is considered to be safe. Thereafter, even when anti (A/B) antibodies recur at high levels they will not harm the kidney transplant, a phenomenon that is called accommodation. In recent years, graft survival rates after ABOi kidney transplantation nearly equaled those after ABO compatible (ABOc) procedures (Becker et al., 2013).
Aim of the study:
This study demonstrates the effect of serial sessions of plasma exchange with albumin replacement on ABO antibody titers.
Patients and methods:
This is a prospective cohort study that enrolled 25 patients on therapeutic plasma exchange sessions for at least five sessions at Ain Shams University Hospitals. Excluding patients with blood group AB, patients with positive direct and indirect antiglobulin tests for autoantibodies, and those on plasma exchange sessions using plasma as a replacement fluid. All patients underwent therapeutic plasma exchange sessions for five sessions. All patients were subjected to informed consent, detailed history taking, full clinical examination, as well as laboratory investigations, including blood grouping, coombs test (direct and indirect), and anti (A/B) antibody titers, were measured before plasma exchange and after each session for five sessions using gel card method. The protocol was approved by the ethics committee of our institution before the study began, and it conformed to the ethical guidelines of the 1964 Helsinki Declaration.
Results:
the study included a total number of 25 patients, 16 men (64%) and 9 women (36%) with mean age 44.24±11.96, 13 patients more than 50 years, and 12 patients less than 50 years. Twelve (48%) had A1 blood group, eight (32%) had blood group B and five (20%) had blood group O. The baseline Anti (A) and Anti (B) antibodies titer before plasma exchange were (median (IQR) 128 (192) and 64 (64) with significant reduction after 5 sessions with (median (IQR) 1 (4) and 2 (1)) respectively with p value<0.001. Anti (A) and Anti (B) antibody titers percent reduction from baseline to 5th session were {mean±SD -99.04±0.72% and -97.9 3±0.99%} respectively. Anti (A) and Anti (B) antibodies titer were negatively correlated with patient’s age (r-0.731, p 0.005 , r -0.793 , P <0.001) respectively. Patients with age <50 (n=13) years have higher anti (A) and anti (B) antibodies compared with patients with age >50 years (N=12) with p value<0.001. Also on comparing Patients on immunosuppressive drugs with patients without as regard baseline antibody titers before exchange sessions and after five plasma exchange sessions, there was no significant difference in anti (B) while anti (A) titers were higher in patients without immunosuppressive drugs with p value<0.05 and on 5th session p-value 0.01.
Conclusion:
Serial plasma exchange sessions with albumin replacement is an effective method for ABO antibody titers reduction. Baseline titers appear to be affected by age and adjuvant immunosuppressive therapy.
Conclusion
Serial plasma exchange sessions with albumin replacement is an effective method for ABO antibody titers reduction. Baseline titers appear to be affected by age and adjuvant immunosuppressive therapy.
Recommendations
1) Plasma exchange is an effective method to be used for antibodies reduction in ABOI kidney transplantation.
2) Follow up period is needed to assess antibodies rebound.
3) Further studies are needed on large numbers.