01 August 2025
: Case report 
Immunoadsorption as a Rescue Therapy for Very High Anti-B Titer in ABO-Incompatible Kidney Transplantation
Unusual clinical course, Challenging differential diagnosis, Unusual setting of medical care
Chanyanuch Rakpithayanon ABE 1, Nattapakorn Mai-on E 1, Sirihatai Konwai
E 1,2, Thunyatorn Wuttiputhanun E 1,3, Natavudh Townamchai E 1,3,4, Methee Sutherasan BE 3,5, Julin Opanuraks BE 6, Yingyos Avihingsanon E 1,3,4, Suwasin Udomkarnjananun ABCEF 1,3,4*
DOI: 10.12659/AJCR.948529
Am J Case Rep 2025; 26:e948529
Table 1 Patient’s data on preconditioning before kidney transplantation.
| Day | IgM | IgG | Post IgM | Post IgG | Procedure/ medication | Total plasma volume (L) | Estimated PV | Tacrolimus C0 (ng/mL) | Complications |
|---|---|---|---|---|---|---|---|---|---|
| −15 | Rituximab 600 mg | ||||||||
| −14 | 256 | 2048 | 6.3 | ||||||
| −13 | 256 | 2048 | 64 | 512 | DFPP | 4.375 | 2.0 | ||
| −12 | 128 | 512 | |||||||
| −11 | 128 | 1024 | 32 | 512 | DFPP | 4.375 | 1.9 | AVF compression >30 min, need adrenaline gauze pack | |
| −10 | 256 | 512 | 14.1 | ||||||
| −9 | 64 | 512 | 16 | 128 | DFPP | 4.375 | 1.8 | AVF compression >30 min | |
| −8 | 32 | 256 | |||||||
| −7 | 64 | 512 | 16 | 128 | DFPP | 5.000 | 2.1 | 9.6 | AVF bleeding, need tourniquet compression |
| −6 | 32 | 256 | |||||||
| −5 | 64 | 512 | 4 | 16 | Glycosorb-ABO B column | 8.750 | 3.7 | ||
| −4 | 16 | 64 | Rituximab 500 mg | ||||||
| −3 | 32 | 256 | 8 | 64 | DFPP | 6.250 | 2.5 | 5.9 | |
| −2 | 16 | 64 | 8 | 32 | DFPP | 6.250 | 2.4 | ||
| −1 | 16 | 64 | 1 | 8 | Glycosorb-ABO B column | 11.000 | 4.3 | ||
| 0 | 2 | 32 | Kidney transplantation | 10.5 | |||||
| AVF – arteriovenous fistula; C – pre-dose concentration; DFPP – double-filtration plasmapheresis; post IgG – post-antibody removal IgG titer; post IgM – post-antibody removal IgM titer. | |||||||||