• Childhood Kidney Diseases
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• v.7 no.1
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• pp.1-8
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• 2003

Purpose : Focal segmental glomerulosclerosis(FSGS) is known to have a poor prognosis and a poor response to treatment. We performed a combination therapy of plasmapheresis, steroid pulse and immunoglobulin in 4 patients with relapsed steroid dependent(SD) or steroid resistant(SR) FSGS after steroid pulse therapy. Materials and Methods : 8 cycles of plasmapheresis were performed in 4 patients with biopsy proven FSGS who had relapsed after steroid pulse therapy from March 1988 to July 2002. Clinical findings and treatment courses were reviewed retrospectively. Results : Among the 4 patients, there were 3 males and 1 female. After 8 cycles of plasmapheresis, clinical remissions were obtained. Two of the four patients had two relapses and received 2 more cycles of plasmapheresis which resulted in remissions. One of these patients had two further relapses and was treated with oral steroid resulting in clinical remission. Three patients have maintained normal serum creatinine level and glomerular filtration rates during the follow-up period of 10 years, and the other 1 patient for 5 months. Conclusion : A combination therapy of plasmapheresis, steroid pulse and immunoglobulin led to a complete remission in patients with FSGS who were SD or SR and was effective in maintaining normal renal function.

• Clinical and Experimental Pediatrics
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• v.58 no.10
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• pp.402-405
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• 2015

IgA nephropathy usually presents as asymptomatic microscopic hematuria or proteinuria or episodic gross hematuria after upper respiratory infection. It is an uncommon cause of end-stage renal failure in childhood. Pulmonary hemorrhage associated with IgA nephropathy is an unusual life-threatening manifestation in pediatric patients and is usually treated with aggressive immunosuppression. Pulmonary hemorrhage and renal failure usually occur concurrently, and the pulmonary manifestation is believed to be caused by the same immune process. We present the case of a 14-year-old patient with IgA nephropathy who had already progressed to end-stage renal failure in spite of immunosuppression and presented with pulmonary hemorrhage during oral prednisone treatment. His lung disease was comparable to diffuse alveolar hemorrhage and was successfully treated with plasmapheresis followed by oral prednisone. This case suggests that pulmonary hemorrhage may develop independently of renal manifestation, and that plasmapheresis should be considered as adjunctive therapy to immunosuppressive medication for treating IgA nephropathy with pulmonary hemorrhage.

• Journal of Chest Surgery
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• v.29 no.3
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• pp.322-325
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• 1996

ABO incompatible allografting is contraindicated in most organ transplantations including heart because of the hyperacute and acute rejections caused by preexisting antibodies. However several reports showed that ABO incompatible organ transplantation could be managed successfully by plasmapheresis, antibody adsorption, immunosuppression, splenectomy, and so on. We experienced one success in ABO incompatible cardiac transplantation by means of plasmapheresis and immunosuppression. However, this does not justify heart transplantation across ABO blood group barriers. Because the effect of ABO incompatibility on continued acute rejection or chronic rejection has not been fully understood, long-term follow-up study is required.

• Childhood Kidney Diseases
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• v.9 no.1
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• pp.38-45
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• 2005

Purpose : The purpose of this study was to analyze the therapeutic effect of plasmapheresis in various pediatric diseases. Methods : Therapeutic plasmapheresis was performed by COBE Spectra centrifugation. Nine cases were included in this study. The number an[;. method of plasmapheresis, together with the progress and prognosis of each case were retrospectively reviewed. Results : The patients' ages ranged from 26 mont]Is to 16 years of age, and the mean age was 9.9 years. There were S males and 4 females. The underlying diseases requiring plasmapheresis included 2 cases of hemolytic uremic svndrome(HUS), 1 case of lupus nephritis, 2 cases of rapidly Progressive glomerulonephritis(RPGN), 1 case of focal segmental glomorulosclerosis(FSGS), 1 case of systemic vasculitis after pulmonary hemorrhage, 1 case of acute renal failure associated with pulmonary hemoIThage, and 1 case of acute rejection after renal transplantation. The average number of plasmapheresis performed was 6.2 times with a range of 3 to 13 times. The patients with HUS, lupus nephritis, ANCA positive systemic vasculitis induced by pulmonary hemorrhage and ARF-associated pulmonary hemorrhage showed a good response to therapeutic plasmapheresis, but the patients with RPGN, refractory FSGS, and acute rejection after renal transplantation were not responsive to treatment. The most common side effect was hypocalcemia which was rarely symptomatic. Vital signs were not compromised. Conclusion : Although it is presumptuous to generalize the therapeutic effects of plasma pheresis in different diseases due to the small number of study subjects, this study shows that plasmapheresis may be an effective therapeutic modality in various pediatrics diseases and should be considered as a therapeutic option.

• Childhood Kidney Diseases
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• v.14 no.1
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• pp.100-104
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• 2010

We report on two children with a high risk of recurrent focal segmental glomerulosclerosis (FSGS) after renal transplantation that could be effectively prevented by prophylactic administration of cyclosporine combined with preemptive plasmapheresis prior to renal transplantation.

• Journal of Chest Surgery
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• v.37 no.5
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• pp.391-400
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• 2004

Xenotransplantation in discordant species results in immediate and irreversible hyperacute rejection due to natural antibodies, IgM. With this, antibody depletion is one option to reduce hyperacute rejection, we investigated the effect of PCPP (postcentrifugal plasmapheresis) on the depletion of natural antibodies and the effect of antibody titer on xenograft survival. Material and Method: Outbred swines (n=4) weighing 10∼20 kg were used as donors and mongrel dogs (n=4) weighing 25∼30 kg were used as recipients. Recipient canines underwent plasmapheresis (COBE TPE Laboratories, Lakewood. CO, USA). Pre-transplantation PCPP was peformed on day －2 and day 0. There were three groups (Group 0: no PCPP, Group 1: 1 pla sma-volume (PV) at day －2 and 2 PV at day 0, Group 2: 2 PV at day －2 and 2 PV at day 0). A swine heart was heterotopically transplanted into a recipient's abdominal infrarenal aorta and inferior vena cava. Mean percent depletion of total IgM and IgG in plasma of the recipients was calculated. Serum albumin, electrolyte, complement activity and coagulation factors were measured. Histopathologic examination of heart specimens was performed. Result: Mean percent depletion of IgM and IgG were 95.7$\pm$1.2%, 80.5$\pm$2.4% in the group 2 at the end of PCPP. The percent depletion of serum albumin concentration was decreased from 2.8 to 1.4 g/㎗ in the group 1 and 3.0 to 1.5 g/㎗ in the group 2. Complement hemolytic activity was decreased in group 1 and 2, but returned to normal level within 24 hours. Complement hemolytic activity was reduced to 10% of pre-PCPP level in group 2. Serum fibrinogen decreased to 20% or less and was recovered within 24 hours in group 2. Antithrombin III decreased but less than fibrinogen. PT and aPTT were sometimes but not always prolonged during plasmapheresis. After plasmapheresis, PT and aPTT were prolonged beyond the measurable level. D-dimer was not found during PCPP, but appeared and maintained from 10 minutes after trasplantation. Graft Survival time was 5 min in group 0, and it was 90$\pm$0 min in the group 2. Histopathologic changes were more typically characterized by edema, hemorrhages, thrombosis in all groups at the end of experiment. Conclusion: PCPP effectively removed immuoglobulins and reduced the titer of natural antibodies, as a result, significantly prololonged swine heart xenograft survival.

• Annals of Clinical Neurophysiology
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• v.13 no.2
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• pp.114-116
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• 2011

• Journal of Chest Surgery
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• v.57 no.2
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• pp.217-219
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• 2024

Matching for the rhesus (Rh) blood group is currently not taken into account in the organ allocation system. However, in Rh-mismatched transplantation, the primary concern is the potential for RhD-negative recipients to develop sensitization and produce anti-D antibodies if they receive a transfusion of RhD-positive blood. It is estimated that over 80% of RhD-negative recipients may experience Rh allosensitization when exposed to RhD-positive blood, although this occurrence is less common in recipients of solid organs. In theory, RhD-negative recipients who receive organs from RhD-positive donors are at risk of alloimmunization and the production of anti-D antibodies, which could complicate future blood product transfusions. However, our understanding of the impact of donor-recipient Rh mismatch on transplant outcomes, particularly in heart transplantation, is limited. We report a case of successful Rh-mismatched heart transplantation, which was effectively managed through the use of preoperative RhD immunoglobulin and plasmapheresis.

• Journal of Chest Surgery
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• v.22 no.2
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• pp.305-307
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• 1989

Cold agglutinins are a potential danger to patients who must be subjected to hypothermia. A patient with a cold agglutinin of moderate titer but broad thermal amplitude was to undergo hypothermia during double valve replacement. She was managed preoperatively with plasmapheresis 5 times. There was no complication during and after operation.

• Journal of Chest Surgery
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• v.47 no.4
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• pp.420-422
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• 2014

A 44-year-old pregnant female patient gave stillbirth while being treated for pneumonia. She developed acute respiratory failure, which resulted in mechanical ventilator support. Diagnostic lung biopsy revealed a cryptogenic organizing pneumonia. The patient's condition deteriorated and a venous-venous extracorporeal membrane oxygenation was placed. She was listed for lung transplantation. Because of her worsening condition lung transplantation was performed despite positive cross matching result. She was treated with rituximab, intravenous immunoglobulin, and plasmapheresis and recovered without event. There is no sign of rejection at the time of last follow-up.