[Effect of plasmapheresis treatment on immunoglobulin and immune complex levels in patients following kidney transplantation].

Five patients who received cadaver kidneys between May 1982 and January 1983 in the Kidney Transplant Centre in Berlin were subjected to two plasmapheresis (= pph.) treatments in addition to basic immunosuppression with Prednisolone and Azathioprine. The decision to use pph. was due to the presence of donor-specific, complement-dependent lymphocytotoxic antibodies (51Cr release test) in the recipient's serum taken immediately before transplantation. The 1st pph. was carried out on the 1st or 2nd day after operation and the 2nd pph. between the 2nd and 4th day. The quantity of plasma exchanged was between 1.6 and 3.1 1 per pph. Four of the five transplants commenced functioning after 12 to 47 days, and one transplant had to be removed. Frequent measurement of the immunoglobulin and immune-complex levels in the serum revealed drastic reduction due to pph. The concentration of immunoglobulin (G, A, M) was reduced by 42-55% after the 1st pph. and by 20-35% after the 2nd. Whereas the IgM level was normalized after a few days, the levels of IgG and IgA only rose again 2-4 weeks later. The immunodeficiency induced by means of pph. and immunosuppression is accompanied by an increased risk of infection. It is therefore considered important that an adequate anti-infectious treatment including i. v. human gammaglobulin be administered parallel to pph. The final evaluation of the efficacy of pph. in protecting transplants will depend on further studies.