Hi Sherri,
Your question about antibodies coming back is a good one...and one that I had as well! Your cells have "memory" so the antibodies are not gone for good (and you wouldn't want them too, as you need some of them so you don't have to live in a bubble!) The idea with the plasmapheresis is that they bring down the levels to where the transplant can be done without having acute rejection, and then keep the levels down while the new kidney establishes itself. As my nephrologist at Mayo, Dr. Gloor, believes, once the new kidney is initially accepted, any further rejection can be handled with the immunosuppressants. For instance, my b-cell count was around 400 pre-transplant, and it needed to be at 300 before transplant (don't ask me details of what the counts mean...there are also specific antigen beads that come into play. Dr. Gloor explained everything to me and my husband in a way that made sense, but I'm afraid I can't explain it myself!) Anyway, my count was at 150 four days before surgery, and on the day of surgery it was at 92! After 2 weeks of treatments post-transplant my antibody count did start going back up (a little above 300), which caused me some concern. Dr. Gloor didn't seem too concerned, and my labs were good, but I did have a biopsy 2 weeks post transplant just to be sure there was no rejection. If some rejection had been indicated, I would have had a spleenectomy which would keep my antibody count down.
My center in Michigan wasn't very proactive, either...in fact, I didn't know anything about plasmapheresis until after I read an article about it. When I asked about it here, I was told that it was "experimental" and "expensive". However, after I had been evaluated at Mayo and had my new surgery date I called the center in Michigan to give them an update on my status. My coordinator said, "We have done a couple of those transplants in the last few months, so the doctor may be willing to do your transplant here after all." Yeah, right! No thanks...I'll go somewhere where they have done a couple of HUNDRED of them, thank you very much!
I don't remember if I posted this link in another thread, but this is a very informative article on positive crossmatch transplants. It's a little old, so some things have changed but is interesting nonetheless:
http://discoverysedge.mayo.edu/abo_posxmatch/All the best to you and your son...there is hope for you, I just know it!!!!