Table 3 Advantages and disadvantages of various methods of antibody removal (
Supplement fluid | Advantages | Disadvantages | |
|---|---|---|---|
TPE | FFP or crystalloid with albumin solution | Simple | Nonselective elimination of other plasma components |
Readily available | Application of FFP is necessary with risk of subsequent infections or anaphylactic reactions | ||
Simultaneous elimination of ABO Abs and HLA Abs, immune-complexes, and unknown circulating factors | |||
Relatively low costs | |||
DFPP | Crystalloid with albumin solution | Selective (only elimination of high molecular weight plasma fractions) | Elimination of other plasma components |
Simultaneous elimination of ABO Abs and HLA Abs, immune-complexes, and unknown circulating factors | Low biocompatibility of the cascade filter Evaflux 2A (Kuraray, Kurashiki, Japan) | ||
No application of FFP needed | |||
Glycosorb-IA (antigen-specific) | Unnecessary | Most selective | No elimination of HLA Abs |
Simple to use technique | In blood type O recipients and AB donors, AB two different columns are needed | ||
Elimination of both IgG and IgM antibodies for ABO antigens | Short shelf life | ||
No replacement fluid is needed | High costs | ||
Immunosorba-IA (nonantigen-specific) | Unnecessary | Selective but less than Glycosorb | Elimination of all Ig fractions |
Simultaneous elimination of ABO Abs and HLA Abs | Different affinity for various Ig-subtypes (insufficient removal of IgG3 and IgM) | ||
No replacement fluid is needed | Rarely anaphylactic reactions triggered by staphylococcus-protein A | ||
High costs | |||
Ig Therasorb-IA (nonantigen-specific) | Unnecessary | Selective but less than Glycosorb | Removal of all Ig-fractions |
Simultaneous elimination of ABO Abs and HLA Abs | High costs, but less costs with double-columns system | ||
Elimination of all Ig-fractions | |||
36 months shelf live | |||
High removal capacity | |||
No replacement fluid is needed | |||
Selective PE | Crystalloid with albumin solution | Simple | Almost no Elimination of IgM-fraction |
Readily available | Elimination of IgG-fractions less than TPE and DFPP | ||
Elimination of IgG-fractions | |||
Fibrinogen mostly preserved | |||
No application of FFP needed |