Safety and Efficacy of Selective Plasma Exchange Versus Conventional Plasma Exchange in Pretransplant Desensitization of ABO-Incompatible Kidney Transplantation.

Selective plasma exchange (SePE) may reduce adverse events associated with fresh frozen plasma (FFP) use during pretransplant desensitization for ABO-incompatible kidney transplantation. We conducted a single-center retrospective cohort study of 75 patients who underwent ABO-incompatible kidney transplantation between January 2020 and April 2024. Of these, 48 received SePE and 27 received conventional plasma exchange (CPE) with FFP. We compared antibody titers at transplantation, perioperative outcomes, and procedure-related adverse events between the groups. Adverse events occurred in 5 patients (10.4%) in the SePE group and 17 patients (63.0%) in the CPE group (p < 0.001). Anaphylactic shock occurred in no patients in the SePE group and 4 patients (14.8%) in the CPE group (p = 0.027). All patients in the SePE group and all but one patient in the CPE group achieved the prespecified preoperative antibody titer target of ≤ 1:32. Neither surgical operating time nor intraoperative blood loss differed significantly between the groups. In this cohort, SePE was associated with fewer procedure-related adverse events than CPE with FFP while achieving the preoperative antibody titer target in all SePE-treated patients.