Original Article

Ann Lab Med 2012; 32(4): 283-288

Published online July 1, 2012

Copyright © Korean Society for Laboratory Medicine.

Role of Plasma Exchange in ABO-incompatible Kidney Transplantation

Soohun Yoo, M.D.1, Eun Young Lee, M.D.1, Kyu Ha Huh, M.D.2, Myoung Soo Kim, M.D.2, Yu Seun Kim, M.D.2,
and Hyun Ok Kim, M.D.1

Departments of Laboratory Medicine1 and Surgery2, Yonsei University Health System, Seoul, Korea

Correspondence to: Hyun Ok Kim
Department of Laboratory Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea
Tel: +82-2-2228-2444
Fax: +82-2-364-1583

Received: January 2, 2012; Revised: March 26, 2012; Accepted: May 25, 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background: In the past, ABO incompatibility was an absolute contraindication for solid organ transplantation. However, multiple recent trials have suggested strategies for overcoming the reactions between graft antigens and recipient antibodies that cause graft rejection. In this study, we determined the usefulness of plasma exchange (PE) for removing anti-A/B antibodies that cause hyperacute/acute humoral graft rejection in patients undergoing ABO-incompatible kidney transplantation. Methods: In our study, 12 patients underwent ABO-incompatible kidney transplantation. All recipients received pre-transplantation conditioning by PE or intravenous immunoglobulin (IVIG) administration. After pre-transplantation conditioning, anti-A/B antibody titers were evaluated, and transplantation was performed when the titer was below 1:8. To assess the transplantation outcome, anti-A/B antibody titers, creatinine level, estimated glomerular filtration rate (eGFR), and proteinuria levels were measured. Results: Anti-A/B antibody titers were below 1:8 in all patients at the time of transplantation. eGFR measured on post-transplant day 14 showed that 10 patients had immediate recovery of graft function, while 2 patients had slow recovery of graft function. Short-term outcomes of ABO-incompatible kidney transplantation (measured as creatinine levels) after reducing anti-A/B antibody titers were similar to those of ABO-compatible kidney transplantation. After transplantation, the anti-A/B antibody titers were below 1:8 in 7 patients, but the remaining 5 patients required post-transplantation PE and IVIG treatment to prevent antigen-antibody reactions. Conclusions: With the increasing demand for kidney donations, interest in overcoming the ABO incompatibility barrier has increased. PE may be an important breakthrough in increasing the availability of kidneys for transplantation.

Keywords: Plasma exchange, ABO blood-group system, Blood group incompatibility, Kidney transplantation