plasmapheresis is widely accepted for the treatment of myasthenia
gravis, Lambert-Eaton syndrome, Guillain-Barré syndrome, chronic demyelinating polyneuropathy,
hyperviscosity syndrome, leukostasis syndrome, Goodpastures syndrome,
cryoglobulinemia, thrombotic thrombocytopenic purpura/hemolytic uremic
syndrome, familial hypercholesterolemia. In addition, its use has been
considered for numerous other diseases, some of which are undergoing
Nephrology Associates of Kentuckiana oversees the process of
plasmapheresis for many treatments of conditions requiring this
One of the
conditions currently under investigation is using plasmapheresis to
allow kidney transplants between incompatible pairs. While this is not
currently being performed in our immediate area, patients of Nephrology
Associates of Kentuckiana, PSC have been referred to regional
transplant centers that offer such approaches.
kidney transplant takes place between a donor and recipient who have
the same or compatible blood type; however, more
than one-third of willing live donors are turned down because their
blood types are not compatible with the person to whom they wish to
donate their kidney.
With a kidney
transplant, if the kidney is donated by an individual who has a
different blood type than the recipient, the body will automatically
create antibodies to combat the "foreign body" (the new kidney) and
therefore the transplant would fail.
In the 1970s,
researchers and the Muscular Dystrophy Association developed a new
approach to remove these antibodies through a mechanical process known
Plasmapheresis began being used in kidney transplant recipients in the
"Many of these patients have
repeatedly been told there is no hope of ever receiving a kidney
transplant," says Robert A. Montgomery,
M.D., D.Phil., Professor of Surgery, Director of the Incompatible
Kidney Transplant Program, Chief of the Division of Transplantation,
and Director of the Comprehensive Transplant Center, at the Johns
Hopkins University and Hospital.
"With this innovation, I can tell any patient who has a live donor and
is medically eligible that they can be transplanted with a high
likelihood of success. This procedure has the potential of increasing
the number of living donor transplant operations by one-third to
How do I
know if plasmapheresis will work for me?
The process involves testing the
proposed recipient to assess the risk of rejection from harmful
antibodies. Next the recipient undergoes plasmapheresis, a process
involving the removal of the plasma portion of the blood that contains
harmful antibodies and the administration of a medication to prevent
their production. The patient is then ready to undergo transplant
surgery where, in addition to receiving a donor organ, the patient's
spleen is removed using minimally invasive surgical techniques. In
some cases, spleen removal can be avoided through the use of a new
drug that creates similar effects.
Post transplant, the patient undergoes additional plasmapheresis
treatments before being discharged from the hospital. He or she will
then take the same immunosuppression medications as patients receiving
a compatible kidney.
How long does
An average course of plasma
exchanges is six to 10 treatments over two to 10 weeks. The time spent
on the machine may be one to three hours. This depends upon the
patient’s weight, height and the amount of plasma to be exchanged.
How does plasmapheresis
A person undergoing
plasmapheresis can lie in bed or sit in a reclining chair. A small,
thin tube (catheter) is placed in a large vein, usually the one in the
crook of the arm, and another tube is placed in the opposite hand or
foot (so that at least one arm can move freely during the procedure).
procedure consists of removal of blood, separation of blood cells from
plasma, and return of these blood cells to the body's circulation,
diluted with fresh plasma or a substitute. Because of concerns over
viral infection and allergic reaction, fresh plasma is not routinely
used. Instead, the most common substitute is saline solution with
sterilized human albumin protein. During the course of a single
session, two to three liters of plasma is removed and replaced.
There are three
centrifugation." Only one venous catheter line is required.
Approximately 300 ml of blood is removed at a time and centrifuged to
separate plasma from blood cells.
centrifugation." Two venous lines are used. This method requires
slightly less blood volume to be out of the body at any one time.
"Plasma filtration." Two venous
lines are used. The plasma is filtered using standard
hemodialysis equipment. It
requires less than 100 ml of blood to be outside the body at one time.
risks associated with plasmapheresis?
Yes, but most can be controlled.
Any unusual symptoms should be immediately reported to the doctor or
the person in charge of the procedure.
The most common problem is a drop in blood pressure, which can be
experienced as faintness, dizziness, blurred vision, coldness,
sweating or abdominal cramps. A drop in blood pressure is remedied by
lowering the patient's head, raising the legs and giving intravenous
Bleeding can occasionally occur because of the medications used to
keep the blood from clotting during the procedure. Some of these
medications can cause other adverse reactions, which begin with
tingling around the mouth or in the limbs, muscle cramps or a metallic
taste in the mouth. If allowed to progress, these reactions can lead
to an irregular heartbeat or seizures.
An allergic reaction to the solutions used to replace the plasma or to
the sterilizing agents used for the tubing can be a true emergency.
This type of reaction usually begins with itching, wheezing or a rash.
The plasma exchange must be stopped and the person treated with
Excessive suppression of the immune system can temporarily occur with
plasmapheresis, since the procedure isn't selective about which
antibodies it removes. In time, the body can replenish its supply of
needed antibodies, but some physicians give these intravenously after
each plasmapheresis treatment. Outpatients may have to take special
precautions against infection.