Abstract: TH-PO0954
Outcomes of Post-Transplant Plasmapheresis in Highly Sensitized Kidney Transplant Recipients with Pretransplant Donor-Specific Antibodies
Session Information
- Transplantation: Clinical - Glomerular Diseases, Infections, and Rejection
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Supapwanich, Palakorn, Division of Nephrology, Department of Internal Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Thotsiri, Sansanee, Division of Nephrology, Department of Internal Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Kitpermkiat, Rungthiwa, Division of Nephrology, Department of Internal Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Tantisattamo, Ekamol, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, United States
- Kantachuvesiri, Surasak, Division of Nephrology, Department of Internal Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Background
While plasmapheresis (PP) is one of the therapeutic modalities for active antibody-mediated rejection (ABMR) in kidney transplant recipients (KTR), its clinical utility for preventing ABMR in the setting of pre-transplant donor-specific human-leukocyte antigen (HLA) antibodies (DSA) is unknown. We aim to examine the association of receiving post-transplant PP with the incidence of ABMR and allograft loss.
Methods
A single-center retrospective cohort study included KTR with pre-transplant HLA antibodies measured on the day of transplant based on their high pre-transplant panel reactive antibody (PRA) of ≥50%. The association between receiving post-transplant PP and time-to-developing ABMR was examined by multiple Cox proportional hazard regression analysis. Due to the number of the study population, Chi-square was also used to assess the association of receiving post-transplant PP and allograft loss.
Results
Of 56 adult KTR undergoing transplant between 4/10/2012 and 10/28/2024 with pre-transplant DSA, mean±SD age was 45±10 years and 90% were female. Most patients had pre-transplant class II DSA (27 patients), followed by class I (26) and both class I and II (3). Median (IQR) PRA was 87% (73, 94). Thirty-five KTR (63%) did not receive PP, while 23 (37%) received 3, 4, 5, 6, and 8 sessions for 11, 1, 6, 2, and 1 patients, respectively. Median follow-up was 2.22 years (range 0.11–12.57). Seventeen KTR (30%) developed ABMR. During median follow-up of 1.45 years (0.71, 4.06), ABMR incidence rate was 0.122 person-years. Compared to those without PP, KTR with PP had 65% lower ABMR risk, though not statistically significant (HR 0.35, 95%CI 0.10, 1.24, P=0.089). Graft loss incidence was 0.003 person-years with median survival of 7.79 years. No graft loss occurred in KTR with PP, while 8 patients (23%) without PP had graft loss (P=0.02). No patient died during the study.
Conclusion
Although post-transplant PP does not lower the risk for ABMR in highly sensitized KTR with pre-transplant DSA, it appears to lower the risk of long-term graft loss. Additional larger longitudinal studies are required to validate these findings.