Immunoadsorption for treatment of antibody mediated rejection after lung transplantation

In the last decade, antibody mediated rejection (AMR) hasemerged as an important risk factor for lung allograft dysfunction andmortality. Several clinical protocols have been proposed to try to removedonor specific antibodies (DSA) and prevent their future development,including intravenous immunoglobulin (IVIG), therapeutic plasma exchange(TPE), rituximab and other. Unlike traditional TPE, immunoadsorption (IAS) isa blood-purification technique that enables the selective removal ofimmunoglobulins from separated plasma through high-affinity adsorbers;advantageously, IAS does not remove other plasma components such asfibrinogen and compounds of the coagulation cascade, reducing potentialadverse effects.Our centre implemented a multimodality strategy including steroids,immunoadsorbption, IVIG and Rituximab.