Fig. 2

Desensitization protocol for ABO-incompatible kidney transplantation. Patients were treated with rituximab (200 mg) 2 weeks before transplantation, followed by one to four sessions of apheresis (initiated with nDFPP or cDFPP, followed by cDFPP, and lastly TPE on the day before transplantation) and intravenous immunoglobulin (100 mg/kg body weight for 3 consecutive days from the day before transplantation). The total number of sessions of plasmapheresis was determined according to the titers of anti-blood group antibodies to achieve acceptable titers before transplantation. Recipients were administered basiliximab as induction therapy and maintenance therapy with triple immunosuppressants (tacrolimus, mycophenolate mofetil, and methylprednisolone). Blood sampling for analysis was performed immediately before and after the first session of cDFPP or nDFPP to avoid the cumulative effect of serial sessions of DFPP. cDFPP: conventional double-filtration plasmapheresis, IVIG: intravenous immunoglobulin, KTx: kidney transplantation, nDFPP: novel double-filtration plasmapheresis, MMF: mycophenolate mofetil, MPZ: methylprednisolone, TAC: tacrolimus, TPE: therapeutic plasma exchange