An essential pillar of antihumoral therapy are the extracorporeal procedures like Therapeutic Plasma Exchange (TPE) and Immunoadsorption, because preformed non-HLA and HLA-ab can be quickly and effectively removed. Another option is to attempt to reduce HLA-ab titer with administration of IVIG (intravenous immunglobulin) and monoclonal antibodies. However, immediate reduction is not possible.
Studies found that Therapeutic Plasma Exchange in parallel with ECMO is feasible, safe, and may be measurable effective at reducing anti-HLA- antibodies and should be considered as part of the treatment for patients with early antibody-mediated rejection after heart transplantation. Therapeutic Plasma Exchange is well tolerated. Besides its lipid-lowering effects it also affects other systems: oxidized LDL particles, coagulation, C-reactive protein, adhesion molecules, plasma viscosity, monocytes, inflammatory HDL particles. These parameters may have a major impact on the deterioration of cardiac allograft vasculopathy.
Rolf Bambauer, Reinhard Latza, Ralf Schiel:
Therapeutic Plasma Exchange and Selective Plasma Separation Methods, 4th Edition.
Pabst ISBN 978-3-89967-732-4