Utilization and importance of timing of therapeutic plasma exchange in kidney transplantation: A single-center experience

Abstract

Introduction: Therapeutic plasma exchange (TPE) is a prominent approach for specific conditions among renal transplant candidates and recipients. The indications of TPE, those related to kidney transplantation, are limited, and knowledge and utilization strategies are blurred. Herein, we aimed to review our clinical experience of TPE among renal transplant recipients. Methods: A total of 69 (40.22 +/- 12.29 years, 40 males, 63.8% deceased donor) ABO blood type-compatible kidney transplant recipients who underwent TPE were evaluated between January 2013 and December 2019. Results: A median of 5 (IQR 4-7) TPE sessions was administered at a median duration of 31 (IQR 3-564) days after transplantation. The main indication was a rejection episode. A total of 61 (39.44 +/- 12.22 years, 24 living donor, 10 re-transplant, 37 male) recipients were successfully discharged with a serum creatinine of 1.39 (IQR 1-1.91) mg/dL, and eGFR of 62 (IQR 39-94) ml/min. Comparing the recipients according to TPE timing, early administered 32 (52.5%) recipients with a median of 4 (IQR 4-7) days after transplantation had better graft survival (62.5% vs. 17.2%, p < 0.001), despite higher mortality rates (25% vs.10%, p < 0.001). The rate of graft loss was higher (62.1% vs. 9.4%, p < 0.001) among the recipients who required TPE during the late post-transplant period (756 [IQR 272-1307] days). Conclusion: According to our findings, TPE could provide beneficial effects on graft and patient outcomes, and the timing of TPE could influence its efficiency. Further studies are needed to support our findings.