Plasmapheresis and RATG-induced Serum Sickness

Recently, Bekir Tanriover et al. reported a beneficial effect of plasmapheresis in renal transplant patient with serum sickness (1). To their knowledge, this was the first report using plasma exchange to treat serum sickness after renal transplantion. However, in 1988 we published our experience with plasmapheresis in renal transplant patients with serum sickness (2). Patients with serum sickness after RATG were randomly allocated in two groups. Group 1 (n=8) was treated with analgesics and group II (n=7) with plasmapheresis. In group I, serum sickness lasted for ± 10–14 days with only a slight beneficial effect of analgesics. Six patients developed decreased renal function, which improved thereafter. The maximal rise in serum creatinine was 226.1±115.6 μ/mol. During plasmapheresis, an immediate relief of fever and arthralgia occurred and after 2 days serum sickness had completely disappeared. Before plasmapheresis, five of the seven patients showed an increased serum creatinine (maximal increase: 137.4±108 μmol/L). After plasmapheresis, serum creatinin decreased in 2–3 days to base values. There were no adverse effects of plasmapheresis. Since that time, plasmapheresis is the standard therapy for RATG-induced serum sickness in our unit. Maarten H.L. Christiaans Johannes P. van Hooff Department of Internal Medicine University Hospital Maastricht Maastricht, the Netherlands