tailieunhanh - UNDERSTANDING THE COMPLEXITIES OF KIDNEY TRANSPLANTATION Part 7

Sinh lý học thận là môn khoa học nghiên cứu về chức năng thận, trong khi thận học là chuyên khoa y học nghiên cứu các bệnh về thận. Bệnh thận rất đa dạng, nhưng các cá nhân mắc bệnh thận thường thể hiện các đặc tính lâm sàng đặc trưng. | ABO-Incompatible Kidney Transplantation 339 In conventional plasmapheresis smaller proteins such as albumin are also removed in addition to pathogenic molecules antibody or high molecular weight proteins. In general plasma separated with a plasma separator is discarded and replaced with the same volume of replacement fluid such as fresh frozen plasma or albumin solution. There are several options of plasmapheresis which separate blood components more selectively. Double filtration plasmapheresis DFPP uses two filters which have different pore sizes. In the first filter blood is separated as plasma and cell components and plasma is further separated by the second filter. Large molecular-weight proteins including immunoglobulins such as anti-donor isoagglutinins are removed while smaller molecular-weight substances such as albumin are returned to the patient s circulation. In this procedure need of replacement is decreased compared with conventional plasmapheresis thus adverse effects related to the replacement fluid can be reduced Fig. 4 Genberg et al. 2010 Tanabe 2007b . In the immunoadsorption specialized adsorption column selectively adsorbs a specific substance such as immunoglobulin or low-density lipoprotein. This process removes the element of interest specifically and the remaining elements are returned to the patients. Many kinds of immunoadsorption devices for the removal of various types of components are commercially available but generally expensive. For the removal of anti-A and -B antibody AB antigen-specific carbohydrate columns Glycosorb AB Glycorex Transplantation AB Lund Sweden were developed Tyden et al. 2005 and have been widely used in more than 400 cases of ABO-I kidney transplantation Genberg et al. 2010 Tyden et al. 2005 Winters et al. 2004 . This procedure could decrease the complications associated with plasma exchange such as coagulopathy and transfusion reactions. Fig. 4. Schematic presentation of double filtration plasmapheresis DFPP .