Published online Oct 28, 2019. doi: 10.5500/wjt.v9.i6.103
Peer-review started: September 1, 2019
First decision: September 20, 2019
Revised: October 2, 2019
Accepted: October 15, 2019
Article in press: October 15, 2019
Published online: October 28, 2019
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.
Core tip: Kidney transplantation is the treatment of choice for patients with end-stage renal disease. However, pre-transplant immunological barriers and post-transplant clinical conditions still influence negatively graft and patient’s survival. Therapeutic aphaeresis can be applied in many of these conditions using a variety of devices and procedural approaches. This topic review will present a critical evaluation of the available modalities and examine the evidence supporting the application of therapeutic aphaeresis in kidney transplantation as an adjunctive therapeutic option in protocols both for pre-operative procedures and during the post-transplant period.