Therapeutic apheresis in kidney transplantation: An updated review  

作　　者：Maurizio Salvadori Aris Tsalouchos 

机构地区：[1]Department of Transplantation Renal Unit,Careggi University Hospital,Florence 50139,Italy [2]Nephrology and Dialysis Unit,Saints Cosmas and Damian Hospital,Pescia 51017,Italy

出　　处：《World Journal of Transplantation》2019年第6期103-122,共20页世界移植杂志

摘　　要：Therapeutic apheresis is a cornerstone of therapy for several conditions in transplantation medicine and is available in different technical variants. In the setting of kidney transplantation, immunological barriers such as ABO blood group incompatibility and preformed donor-specific antibodies can complicate the outcome of deceased-or living-donor transplantation. Postoperatively,additional problems such as antibody-mediated rejection and a recurrence of primary focal segmental glomerulosclerosis can limit therapeutic success and decrease graft survival. Therapeutic apheresis techniques find application in these issues by separating and selectively removing exchanging or modifying pathogenic material from the patient by an extracorporeal aphaeresis system. The purpose of this review is to describe the available techniques of therapeutic aphaeresis with their specific advantages and disadvantages and examine the evidence supporting the application of therapeutic aphaeresis as an adjunctive therapeutic option to immunosuppressive agents in protocols before and after kidney transplantation.Therapeutic apheresis is a cornerstone of therapy for several conditions in transplantation medicine and is available in different technical variants. In the setting of kidney transplantation, immunological barriers such as ABO blood group incompatibility and preformed donor-specific antibodies can complicate the outcome of deceased-or living-donor transplantation. Postoperatively,additional problems such as antibody-mediated rejection and a recurrence of primary focal segmental glomerulosclerosis can limit therapeutic success and decrease graft survival. Therapeutic apheresis techniques find application in these issues by separating and selectively removing exchanging or modifying pathogenic material from the patient by an extracorporeal aphaeresis system. The purpose of this review is to describe the available techniques of therapeutic aphaeresis with their specific advantages and disadvantages and examine the evidence supporting the application of therapeutic aphaeresis as an adjunctive therapeutic option to immunosuppressive agents in protocols before and after kidney transplantation.

关 键 词：Kidney transplantation Therapeutic plasma exchange Double-filtrationplasmapheresis IMMUNOADSORPTION EXTRACORPOREAL PHOTOPHERESIS DESENSITIZATION ANTIBODY-MEDIATED rejection Focal segmental GLOMERULOSCLEROSIS 

分 类 号：R69[医药卫生—泌尿科学]