Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Oct 28, 2019; 9(6): 103-122
Published online Oct 28, 2019. doi: 10.5500/wjt.v9.i6.103
Therapeutic apheresis in kidney transplantation: An updated review
Maurizio Salvadori, Aris Tsalouchos
Maurizio Salvadori, Department of Transplantation Renal Unit, Careggi University Hospital, Florence 50139, Italy
Aris Tsalouchos, Nephrology and Dialysis Unit, Saints Cosmas and Damian Hospital, Pescia 51017, Italy
Author contributions: Salvadori M and Tsalouchos A contributed equally to the manuscript; Salvadori M designed the study, performed the last revision and provided answers to the reviewers; Tsalouchos A collected the data from literature; Salvadori M and Tsalouchos A analyzed the collected data and wrote the manuscript.
Conflict-of-interest statement: Salvadori M and Tsalouchos A do not have any conflict of interest in relation to the manuscript, as in the attached form.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Maurizio Salvadori, MD, Professor, Department of Transplantation Renal Unit, Careggi University Hospital, Viale Pieraccini 18, Florence 50139, Italy.
Telephone: +39-55-597151 Fax: +39-55-597151
Received: September 1, 2019
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.

Keywords: Kidney transplantation, Therapeutic plasma exchange, Double-filtration plasmapheresis, Immunoadsorption, Extracorporeal photopheresis, Desensitization, Antibody-mediated rejection, Focal segmental glomerulosclerosis

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.