Clinical Application Of PE And DFPP In ABO Incompatible Kidney Transplantation

【Purpose】Analyze and compare the efficacy and safety assessment of dual plasmapheresis(double filtration plasmapheresis,DFPP)versus single-weight plasmapheresis(plasma exchange,PE)in patients with ABO incompatible relatives(ABOincompatible kidney transplantation,ABOi-KT).【Methods】A retrospective analysis of 20 patients with renal biopsy admitted in our hospital from January 2020 to October 2022,all patients had long-term regular hemodialysis treatment,and cross-blood type renal transplantation was performed according to their clinical conditions.According to the different methods of DFPP or PE treatment before renal transplantation,it were divided into PE group and DFPP group to compare the changes of serum creatinine,urea,glomerular filtration rate,albumin,alanine transaminase(ALT),aspartate aminotransferase(AST),neutrophils,and other statistical indicators before and 1 month after renal transplantation.【Results】After PE and DFPP treatment in the two groups,the antibody titer of the blood group in vivo was significantly reduced,and there was no significant difference in the postoperative antibody rebound rate comparison(P> 0.05).In the ABOi-KT patients treated with DFPP,Urea(24.54±8.34)mmol/L vs(8.76±3.49)mmol/L,P<0.01;Creatinine(688.60±188.93)umol/L vs(132.84±46.07)umol/L,P<0.01.Filter rate of(8.10±2.03)ml/min vs(62.3±22.87)ml/min,P<0.01.The percentage of neutrophils(83.23±11.51)% vs(69.08±7.56)% were all significantly decreased,Compared with the ABOi-KT patients treated with PE,No statistically significant difference in efficacy,P>0.05.However,there was no significant difference in albumin,alanine transaminase,and aspartate aminotransferase.By comparing other statistical indicators in the DFPP and PE groups,the incidence of adverse reactions was 9.8% vs30.6%,P <0.05,and total plasma use 0.25(0-2.06)L vs 4.55(3.73-6.15)L,P <0.01.【Conclusion】1.The treatment of ABOi with DFPP and PE can help patients reduce plasma antibodies,serum creatinine and blood urea nitrogen,and improve the glomerular filtration rate of ABOi-KT.2.Compared with PE,DFPP treatment in ABOi-KT patients has less adverse reactions,fewer risk,and is not limited by plasma source,which can ensure the timeliness and continuity of treatment and safer treatment.However,considering the higher cost of treatment,it is still necessary to be selected according to the actual situation of patients in clinical application.