Plasmapheresis is an extracorporeal blood purification technique designed for the removal of large molecular weight substance (eg antibodies, paraproteins) from the plasma. Plasmapheresis in ABO-mismatched marrow transplant recipient is generally accepted as category II indication in a supportive role. Plasmapheresis in Organ transplant rejection is not clearly indicated, as category III indication.

　　Elective plasmaphresis is performd in ABO incompatible (ABOI) or highly HLA-presensitized patients (defined as ?80% panel reactive antibody [PRA]) to remove the harmful antibodies.

　　In addition to ABOI in kidney transplantation, there was also report of ABOI heart transplantation (HT) in infants (West LJ, et al. N Engl J Med 2001; 344: 793-800). Plasma exchange was performed during cardiopulmonary bypass; no other procedures for the removal of antibodies were used. Standard immunosuppressive therapy was given, and rejection was monitored by means of endomyocardial biopsy. No hyperacute rejection occurred. No morbidity attributable to ABO incompatibility has been observed during the follow-up ranged from 11 months to 4.6 years. The mortality rate among infants on the waiting list declined from 58% to 7%.

　　Plasmapheresis could effectively remove donor-specific, anti-HLA antibody, rescuing patients with established antibody-mediated rejection and preemptively desensitizing recipients who had positive cross-matches with a potential donor.
Pretransplant plasmapheresis followed by intravenous immunoglobulin G is proved an effective therapy that allows sensitized patients to undergo HT.

　　We evaluated the effect of plasmapheresis for acute hunmoral rejection after HT at National Taiwan University Hospital. We found that plasmapheresis with concurrent rescue immunosuppression was an effective treatment for acute humoral rejection in HT even with unstable hemodynamics.