T WIDODO1, I KUSWADI2, H PRASANTO3, I PUSPITAWATI4
1Sardjito Hospital, Yogyakarta, Indonesia, 2Sardjito Hospital, Yogyakarta, Indonesia, 3Sardjito Hospital, Yogyakarta, Indonesia, 4Sardjito Hospital, Yogyakarta, Indonesia
Background: Acute kidney graft rejection caused by antibody mediated is common problem in kidney transplantation. Antibody mediated rejection is B cell mediated rejection directed againts human leucocyte antigen (HLA). Plasmapharesis is one of desenzitation procedure for kidney transplants recipient who have high level HLA antibodies positive crossmatch. Plasmapharesis can reduced HLA antibodies level and diminished antibody mediated rejection. Plasmapharesis sometimes was combined with immunospressive agents and intravenous immunoglobulin (IVIG) as desenzitation procedure for transplantation patients.
Case: A male 42 years old diagnosed end state renal diseases, routine hemodialysis, undergoing kidney transplantation with unrelated donor with HLA matching results 7/16. Plasmapharesis combine with immunosuppressive monoclonal antibodies and IVIG was taken as desensitization procedure pretransplantation. Post desensitization, renal transplantation was done with good physical and laboratory examination results, no signs of acute rejection were found.
Discussion: Plasmapharesis is a mechanical procedure for high level HLA antibody positive recipients. Plasmapharesis requiring adequate equipment which is not always available in Indonesian hospital. Plasmapharesis would decreased HLA antibodies level in kidney transplant recipients and proposed as one of desensitisation procedure. Plasmapharesis combined with immunosupressive agents and IVIG would decreased antibody mediated rejection risk. In this case, plasmapharesis proved to be beneficial in lowering HLA antibodies level and clinically useful.
Keyword: Plasmapharesis, HLA antibodies, kidney transplantation.
I’m a fellowship program in Renal and Hypertension Division, Internal Medicine, Sarjito Hospital