Comparison of estimated blood loss during living kidney transplantation according to the number of double-filtration plasmapheresis
Abstract Background Plasmapheresis is an important preoperative desensitization treatment for ABO-incompatible living kidney transplantation. However, in cases with plasma exchange therapy (PET), it is necessary to consider the risks of perioperative bleeding and healthcare economic costs. This stud...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-04-01
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| Series: | Renal Replacement Therapy |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s41100-024-00544-0 |
| _version_ | 1797199197823303680 |
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| author | Takafumi Yagisawa Taichi Kanzawa Yuya Fujiwara Taro Banno Ayaka Saito Rikako Oki Kohei Unagami Toshihito Hirai Kazuya Omoto Norio Hanafusa Hideki Ishida Toshio Takagi |
| author_facet | Takafumi Yagisawa Taichi Kanzawa Yuya Fujiwara Taro Banno Ayaka Saito Rikako Oki Kohei Unagami Toshihito Hirai Kazuya Omoto Norio Hanafusa Hideki Ishida Toshio Takagi |
| author_sort | Takafumi Yagisawa |
| collection | DOAJ |
| description | Abstract Background Plasmapheresis is an important preoperative desensitization treatment for ABO-incompatible living kidney transplantation. However, in cases with plasma exchange therapy (PET), it is necessary to consider the risks of perioperative bleeding and healthcare economic costs. This study investigated the association between intraoperative blood loss and the frequency of preoperative double-filtration plasmapheresis (DFPP) and explored the correlation between DFPP frequency and coagulation factors. Furthermore, the study examined the incidence of perioperative bleeding complications. Methods We enrolled 294 patients (205 men and 89 women) who underwent living kidney transplantation at our institution between January 2020 and March 2023, without PET or with only DFPP performed as PET. A single dose of rituximab (200 mg) was administered to ABO-incompatible living kidney transplant patients within 7 days before transplantation. In these patients, PET was performed until anti-blood group IgG and IgM antibody titers were reduced to 32 times or less. Results The intraoperative blood loss increased in accordance with the DFPP sessions. The amount of bleeding significantly increased when DFPP was performed ≥ 2 sessions. Considering this, we initiated serum fibrinogen level measurements from the middle of the study and observed that serum fibrinogen levels decreased in correlation with the number of DFPP sessions. Fibrinogen levels dropped to critical levels (< 100 mg/dL) after three sessions of DFPP. Within the entire cohort, four patients (1.4%) underwent post-transplantation hematoma removal surgery, and among them, three had received DFPP before transplantation. Conclusions The number of DFPP procedures was associated with the amount of bleeding and serum fibrinogen levels during living kidney transplantation. |
| first_indexed | 2024-04-24T07:11:56Z |
| format | Article |
| id | doaj.art-788ec34250ae4777827380697e8f95e2 |
| institution | Directory Open Access Journal |
| issn | 2059-1381 |
| language | English |
| last_indexed | 2024-04-24T07:11:56Z |
| publishDate | 2024-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Renal Replacement Therapy |
| spelling | doaj.art-788ec34250ae4777827380697e8f95e22024-04-21T11:30:57ZengBMCRenal Replacement Therapy2059-13812024-04-011011610.1186/s41100-024-00544-0Comparison of estimated blood loss during living kidney transplantation according to the number of double-filtration plasmapheresisTakafumi Yagisawa0Taichi Kanzawa1Yuya Fujiwara2Taro Banno3Ayaka Saito4Rikako Oki5Kohei Unagami6Toshihito Hirai7Kazuya Omoto8Norio Hanafusa9Hideki Ishida10Toshio Takagi11Department of Urology, Tokyo Women’s Medical UniversityDepartment of Urology, Tokyo Women’s Medical UniversityDepartment of Urology, Tokyo Women’s Medical UniversityDepartment of Urology, Tokyo Women’s Medical UniversityDepartment of Organ Transplant Medicine, Tokyo Women’s Medical UniversityDepartment of Organ Transplant Medicine, Tokyo Women’s Medical UniversityDepartment of Organ Transplant Medicine, Tokyo Women’s Medical UniversityDepartment of Urology, Tokyo Women’s Medical UniversityDepartment of Urology, Tokyo Women’s Medical UniversityDepartment of Blood Purification, Tokyo Women’s Medical UniversityDepartment of Urology, Tokyo Women’s Medical UniversityDepartment of Urology, Tokyo Women’s Medical UniversityAbstract Background Plasmapheresis is an important preoperative desensitization treatment for ABO-incompatible living kidney transplantation. However, in cases with plasma exchange therapy (PET), it is necessary to consider the risks of perioperative bleeding and healthcare economic costs. This study investigated the association between intraoperative blood loss and the frequency of preoperative double-filtration plasmapheresis (DFPP) and explored the correlation between DFPP frequency and coagulation factors. Furthermore, the study examined the incidence of perioperative bleeding complications. Methods We enrolled 294 patients (205 men and 89 women) who underwent living kidney transplantation at our institution between January 2020 and March 2023, without PET or with only DFPP performed as PET. A single dose of rituximab (200 mg) was administered to ABO-incompatible living kidney transplant patients within 7 days before transplantation. In these patients, PET was performed until anti-blood group IgG and IgM antibody titers were reduced to 32 times or less. Results The intraoperative blood loss increased in accordance with the DFPP sessions. The amount of bleeding significantly increased when DFPP was performed ≥ 2 sessions. Considering this, we initiated serum fibrinogen level measurements from the middle of the study and observed that serum fibrinogen levels decreased in correlation with the number of DFPP sessions. Fibrinogen levels dropped to critical levels (< 100 mg/dL) after three sessions of DFPP. Within the entire cohort, four patients (1.4%) underwent post-transplantation hematoma removal surgery, and among them, three had received DFPP before transplantation. Conclusions The number of DFPP procedures was associated with the amount of bleeding and serum fibrinogen levels during living kidney transplantation.https://doi.org/10.1186/s41100-024-00544-0ABO incompatibleDouble-filtration plasmapheresisFibrinogenKidney transplantation |
| spellingShingle | Takafumi Yagisawa Taichi Kanzawa Yuya Fujiwara Taro Banno Ayaka Saito Rikako Oki Kohei Unagami Toshihito Hirai Kazuya Omoto Norio Hanafusa Hideki Ishida Toshio Takagi Comparison of estimated blood loss during living kidney transplantation according to the number of double-filtration plasmapheresis Renal Replacement Therapy ABO incompatible Double-filtration plasmapheresis Fibrinogen Kidney transplantation |
| title | Comparison of estimated blood loss during living kidney transplantation according to the number of double-filtration plasmapheresis |
| title_full | Comparison of estimated blood loss during living kidney transplantation according to the number of double-filtration plasmapheresis |
| title_fullStr | Comparison of estimated blood loss during living kidney transplantation according to the number of double-filtration plasmapheresis |
| title_full_unstemmed | Comparison of estimated blood loss during living kidney transplantation according to the number of double-filtration plasmapheresis |
| title_short | Comparison of estimated blood loss during living kidney transplantation according to the number of double-filtration plasmapheresis |
| title_sort | comparison of estimated blood loss during living kidney transplantation according to the number of double filtration plasmapheresis |
| topic | ABO incompatible Double-filtration plasmapheresis Fibrinogen Kidney transplantation |
| url | https://doi.org/10.1186/s41100-024-00544-0 |
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