Desensitization and Pheresis in Kidney Transplant

Trenches in Transplant Surgery · Oct 3, 2025 · 56m

Desensitization has transformed kidney transplantation for patients with high immunologic risk by lowering or removing antibodies that would otherwise cause graft loss. Pre- and peri-transplant plasmapheresis (therapeutic plasma exchange) with low-dose intravenous immunoglobulin (IVIG), sometimes combined with B-cell depletion (rituximab) or newer agents (imlifidase, bortezomib, daratumumab), is standard for HLA- or ABO-incompatible living and deceased donor transplants. Plasmapheresis is also first-line therapy for antibody-mediated rejection and for recurrent focal segmental…