Therapeutic Plasma Exchange as a Pre-Conditioning Regimen in ABO Incompatible Renal Transplant- Experience from Largest Transplant Institute in Gujarat, India

Background: ABO non-identical renal transplantation is becoming increasingly common to overcome the unavailability/ shortage of ABO identical donor(s). This study was conducted to evaluate whether Plasma exchange is an effective method in reducing ABO titers to desired levels in ABO Incompatible renal transplant recipients, as used as a part of desensitization regimen. Methods: A retrospective observational analysis was done in 11 patients taken for ABOi renal transplant from February 2022 to April 2024. All the 11 patients were treated with Plasma exchange procedures according to the institutional protocol for ABOi renal transplant recipients. Patients with a maximum baseline Anti-blood group (ABO) IgG titer of 512 were considered for such ABOi renal transplants and subsequent plasma exchanges. The purpose of plasma exchange along with immunosuppression was to lower the ABO isohemagglutinin titer to ≤ 4. Statistical analysis was done using Microsoft Excel, Windows. Data were reported as mean ± standard deviation, values and Percentages. Results: An average of 4.27 pre-transplant plasma exchanges were performed to lower the antibody titer to ≤ 4, along with the standard protocol containing immunosuppressive agents. A maximum and minimum number of plasma exchanges done in each of the patients were 7 and 1, respectively. During the postoperative 1 month follow up the serum creatinine level was maintained at around 1.84 mg/dl in all patients. All patients in the present study showed a high level of compliance with Plasma exchange with only mild adverse reactions. Conclusion: Plasma exchange can be regarded as a safe and effective method in decreasing the ABO titer to the desired level, in ABOi renal transplant recipients.