Therapeutic apheresis in kidney transplantation: An updated review

Table 1 Therapeutic apheresis techniques performed in the setting of kidney transplantation

TPE

cTPE

mTPE

Selective therapeutic apheresis techniques

DFPP

IA

IA using immobilized antibodies

IA using immobilized staphylococcal protein A

IA using immobilized antigens and synthetic epitopes

ECP

TPE: Therapeutic plasma exchange; cTPE: Centrifugal therapeutic plasma exchange; mTPE: Membrane therapeutic plasma exchange; DFPP: Double filtration plasmapheresis; IA: Immunoadsorption; ECP: Extracorporeal photopheresis.

Table 2 Clinical indications for therapeutic apheresis in kidney transplantation

Desensitization in ABO-i kidney transplantation

Desensitization in patients with preformed HLA-antibodies

Desensitization of deceased donor kidney transplant recipients

Desensitization of living donor kidney transplant recipients

AMR

Recurrence of primary FSGS

Prevention of recurrence and recurrence of complement-mediated aHUS

De novo TMA

Antiphospholipid syndrome and systemic lupus erythematosus

Recurrent and de novo anti-GBM disease

Recurrence of ANCA- AAVs

ABOi: ABO incompatible; HLA: Human leukocyte antigens; AMR: Antibody-mediated rejection; FSGS: Focal segmental glomerulosclerosis; aHUS: Atypical haemolytic uremic syndrome; TMA: Thrombotic microangiopathy; GBM: Glomerular basement membrane; ANCA: Antineutrophil cytoplasmic antibody; AAVs: ANCA associated vasculitis.