Abstract
A 52-year-old woman, whose blood type was O+, underwent ABO-incompatible living renal transplantation from her AB+ husband. We performed plasma exchange (PE) for three times before transplantation to remove anti-A and anti-B antibodies. The serum anti-A IgG/IgM titers were ×1/×16 and anti-B IgG/IgM titers were ×1/×4, respectively. Tacrolimus, methylprednisolone, antilymphocyte immunoglobulin, deoxyspergualin and mycophenolate mofetil were administered in perioperative period. The function of transplant kidney deteriorated in the first postoperative day despite good urination immediately after the surgery. We diagnosed it as vascular rejection from clinical manifestations (not proven by biopsy) and introduced PE without delay to remove the anti-A and anti-B antibodies. A total of eight PEs in the postoperative period improved kidney function and successfully suppressed antibody titers. The patient was discharged from the ICU on the 13th postoperative day. As a conclusion PE should be performed aggressively when vascular rejection is suspected.
