Plasmapharesis questions

[KT0930]

I am currently waiting on my third transplant, and because of that, plus a pregnancy plus transfusions, my PRA is 93%. I have done some research and read some stories on here (thanks everyone!) about plasmapharesis. What I'm wondering is, are there any matching or compatability requirements for the recipient and donor? My brother (and several others) have been tested, and our blood types work together, but the cross-match always comes back positive. Is there anything special about the positive cross-match that needs to be considered before they'll do plasmapharesis?

Any input before I take the next steps (asking my bro again and getting files sent for consideration) would be great. Thanks!

[Wattle]

  

I thought that a Positive Cross Match was still o.k for a Live Donor if Plasmapharesis and IVIG therapy was completed before Transplant.


Any more Ideas?? Okarol help.......

[okarol]

I don't know what would exclude a donor - but maybe Jill knows.

This is regarding IVIG - intravenous immunoglobulin - http://www.uspharmacist.com/index.asp?show=article&page=8_1242.htm - it's from 2004 but I believe it's accurate.

Candidate Screening
Use in Living Donor Transplantation: Cedars-Sinai Medical Center recently started an NIH-funded protocol using IVIG to lower antibodies in ESRD patients. To be eligible, patients must have a living donor and a negative in vitro IVIG crossmatch. The in vitro IVIG crossmatch is performed by adding IVIG to the patient's serum in a 1:1 dilution. Patients whose in-vitro IVIG crossmatches show inhibition are given a dose of IVIG 2 g/kg (maximum of 140 g) every month, up to four doses, given on dialysis. A repeat crossmatch is done after each infusion, and if the crossmatch becomes negative, then the transplantation proceeds. We have referred more than 60 living donor transplants with this protocol. Our initial data on 42 transplants was recently published.15

Cadaveric Transplant: Patients awaiting a cadaveric transplant are candidates for the Cedars-Sinai IVIG protocol if they have been on the UNOS list for more than five years, do not have acceptable living donors, have consistently had positive crossmatches to cadaveric organs, and have an in-vitro IVIG crossmatch test that shows inhibition by IVIG. These patients receive 2 g/kg of IVIG while on dialysis once per month for four months. Following this regimen, they are again tested for a crossmatch, and if a crossmatch-negative kidney is found, they receive the transplant.

Poor Responders: IVIG therapy is not effective 100% of the time. High-risk patients who do not achieve a low PRA score with the IVIG crossmatch, or whose PRA does not drop following IVIG pretreatment, may require plasmapheresis/IVIG treatment for a successful transplant. 

[Beth36]

I will try and answer your question in a way that makes sense because I don't know all the terminology but I will try.....my mom has a high PRA and is O, so my hubby, myself, and my youngest sister all tested to donate to her since we are all O.  We were all a 3 antigen match but positive crossmatch.  Mayo then does another test to see just how strong positive the crossmatch is (and I can't remember what it is called because I don't have my "notes" from this summer when we were testing, etc.) and after that test, my hubby and I were not able to donate because our levels were high.  It turned out my sister was the best match.  My mom only needs plasmapheresis after transplant getting a kidney from my sister, although her levels went up some before she was tested in November.  They need a special medicine that they use on high PRA/positive crossmatch patients and I don't know the name of it because my dad didn't write it down but she will be getting it in February before she has her operation.  I hope that sort of made sense.....I'm living on a little bit of sleep since my 3 year old has started having night terrors, so I'm not too with it but saw your post and wanted to help as much as I can.  I'll try to dig out my notes, etc if Jill doesn't see this post before I can do that.....good luck!!!!


Beth

[Rerun]

So if my blood type is A and my living donor is AB can we do the IVIG therapy and plasmapheresis?

[tamara]

So if my blood type is A and my living donor is AB can we do the IVIG therapy and plasmapheresis?

Allan was an A and I was a B, so I can't see why not, just depends on how high your PRA is.

[Wattle]

So if my blood type is A and my living donor is AB can we do the IVIG therapy and plasmapheresis?

Allan was an A and I was a B, so I can't see why not, just depends on how high your PRA is.

Tamara, was your inital crossmatch positive or negative? Can it still go ahead with a positive crossmatch?   

[Beth36]

I know the Mayo does positive crossmatch and ABO incompatible transplants as well....my brother is A and wanted to donate to my mom but we decided to go with my sister because since her PRA is high, I think they'd have to take out her spleen AND do IVIg and/or plasmapheresis.....I think that's how it's done there but again, I'm not positive.  The test after crossmatch is called a flow crossmatch.  It tests to see what antibodies are the most reactive.  T cell and B cell.......sorry to chime in late and in another discussion but I had to put it out there now that I've had a chance to sleep...lol...good luck to all considering this option!!!


Beth